The ideal patient for toric cataract surgery

The selection of the patient for cataract surgery with toric IOLs is a very delicate issue and we have decided to discuss it with José L. Güell who is not only one of the best cataract refractive surgeon but also has a thorough scientific background as professor of Ophthalmology and ESASO coordinator and is renowned in the international ophthalmological field as past-president of EUCORNEA and ESCRS.

Fig. 1. Pre-operative markers.
Fig. 1. Pre-operative markers.

Who is the ideal patient for cataract refractive surgery with toric IOL?
The precision in correcting astigmatism for most Toric pseudophakic IOL’s available today is quite high. Most models have demonstrated quite high predictability and, most important, stability of the correction.
That is why today, in my practice, most patients with stable corneal astigmatism are good candidates for Toric IOL implantation.
Taking into account the adequate rotational stability of most IOL models, the critical point is a proper alignment.
That is why an adequate preoperative evaluation including both anterior and posterior corneal astigmatism, as well as an adequate surgical alignment technique are mandatory.

Fig. 2. Pre-operative marks at the ophthalmoscope.
Fig. 2. Pre-operative marks at the ophthalmoscope.

In between the current available alignment techniques, we may use the simplest or the more sophisticated ones, without significant clinical and refractive differences between them if we review the published work.
On the simplest side, I would like to mention the use of a preoperative reference mark (on the ophthalmometer or with the Elies marker or Robomarker for example) or the use of the topographic image on a high quality ocular surface photography (as the one that the Cassini topographer provides) where you may clearly see the steepest meridian and distinguish limbal details and, on the more sophisticated side, we may use different systems.
The ones I have worked with are: the Verion from Alcon, the Callysto from Zeiss and the Trueguide System from Truevision (see pictures).


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Dr. Carmelo Chines
Direttore responsabile