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    IOL centration stable 30 days after implantation, study confirms


    Reassuring data

    The findings should also be reassuring for surgeons in that both dominant technologies–conventional cataract surgery and FLACS–produce similar centration results whether the patient receives a monofocal IOL or a toric IOL. With either procedure, the shift in centration over the 30 days following surgery is detectable using ray-tracing technology, but the shift appears to be small and not clinically significant.

    “There has been some concern about the optimization of cataract surgery for multifocal IOLs somehow requiring the use of a femtosecond laser system,” Dr. Cabot explained. “We did not see any clinically significant difference in results from day 1 to day 30 in lens centration from using FLACS compared to conventional cataract surgery or between monofocal and toric IOLs. We would all like to see further studies to confirm these results with multifocal IOLs.”

    Figure 3. Traditional cataract surgery supero-nasal IOL shift relative to pupil center: IOL shift between POD #1 and POM #1 relative to pupil center (A), limbus center (B), and vertex (C).Ray-tracing technology has obvious limitations, she continued. That suggests using other technologies, such as high-resolution optical coherence tomography (OCT) or a Scheimpflug camera, such as the Pentacam, to confirm the results with a richer data set.

    It would also be helpful to add a third data collection point immediately after surgery. Ophthalmologists typically spend a few minutes positioning IOLs and, in the case of toric lenses, rotating the IOLs for optimal visual effect. It is widely recognized that the capsular bag may contract asymmetrically in some individuals, but little is known about why or when that contraction occurs.

    The single largest unknown may be positioning changes that take place in the hours immediately following surgery. Dr. Cabot said that adding an intraoperative evaluation of IOL centration could help ophthalmologists evaluate the effect of early changes compared to day 1, 30 days, and possibly longer after surgery.

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