Positioning Toric IOLs
With the Devgan Axis Marker (Accutome, Malvern, PA), Uday Devgan, MD, marks the steep corneal axis at the slit-lamp microscope prior to surgery. He enhances the epithelial marks by using a cystotome to puncture the anterior stroma to create marks that are visible at the time of surgery via the red reflex of the operating microscope. The lens should be placed just short of the mark while viscoelastic is in the eye to make it easier to rotate the IOL clockwise. After removing all viscoelastic from behind the toric IOL, he nudges the IOL into the correct alignment while keeping the eye inflated with the I/A probe.
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Comments (5)
such a nice pretty pretty pretty video , i had a huge blast watching this video. Dr Matias Iglicki
such a nice pretty pretty pretty video , i had a huge blast watching this video. Dr Matias Iglicki
We must control postural cyclotorsion but also , acomodative and monocular. How do you control monocular and accomodative cyclotorsion with your method. Do you control those features when you measure the keratometry? Thanks for your excellent collection of videos
With a hydrophobic acrylic lens like the Alcon Acrysof toric, there is a 'tacky' sticky nature to the IOL. This is why the IOL is able to stay at a particular rotational axis. The flexible haptics of the Acrysof lens are easily deformable and as such, it is relatively easy to change the centration of the IOL and have it remain in place. Be sure to remove the viscoelastic from behind the IOL, center the IOL where you want it, then push posteriorly on the IOL optic to "tack" it into place. It will remain there -- try it.
I enjoyed your video and appreciate you sharing these pearl with us. I do have a question and it all could be semantics. Irregardless of how we determine and mark the steep meridian for subsequest toric iol alignment, would not lens "centration" be determined soley by the anatomy of the capsular sulcus. No matter how we align the toric marks on the lens, the lens itself will "settle" into the bag and center the same way no matter how we mark and align for astigmatism. I agree that using the visual axis as our reference point is preferrable, but this should not affect the overall centration of the lens. If I am mistaken please elucidate, as I've had these doubts for a long time.