The authors of this poster have no financial interest in any products and technologies mentioned in this presentation.

Introduction Key point of successful T-ICL implantation is

exact lens axis alignment.

Starting point: estimation and marking of main meridian

of the cornea (horizontal or vertical).

Second step: having main meridian as a reference,

estimation and marking of the exact meridian of the lens alignment.

Classical 2 Steps Approach for Estimation and Marking of Corneal Meridians:First Step (Pre-Operative):

Second Step (Intra-Operative):

Estimation and Marking of Horizontal Meridian:

«By Sight» By Gravity Marker By Horizontal Slit of Slit

Lamp

marking of the exact meridian of the lens alignment (Mendoz Ring or Similar Instruments).

Advantages and Disadvantages of 2 Steps Classical Corneal Marking:

Advantages: Disadvantages:

1) Time Consuming2) Additional Intra-

Operative Manipulations

3) Grating Period of Instruments – 10 Degree of Arc = Low Accuracy

Optimal Marking:

1. Pre-Operative2. One Step3. By Precision

Protractor

Corneal Marking, NOT Conjunctival Conjunctival Marker size is ≈ 5 Degree of Arc

Corneal Spatula is More Precise

Methods: Retrospective analysis of 2 Groups of Patients withHigh Myopic

Astigmatism corrected by T-ICL implantation. Both groups were matching in age, statue and degree of myopia:

Patients were followed up 1 day, 1 week, 1, 3, and 6 months postoperatively.

Purpose: To evaluate the efficacy, safety and stability of High Myopic

Astigmatism correction by Phakic Posterior Chamber Toric Intraocular Lens (T-ICL, STAAR, Switzerland).

T-ICLs aligned by classical 2 Steps procedure

+ clear corneal tunnel

T-ICLs aligned by direct preoperative marking of horizontal and exact axis of the lens orientation under SL with 360° ocular protractor

+ limbal-corneal

tunnel

Real T-ICL patient photo

Results: 6 months

Comments:

Axis Misalignment of T-ICL

7.3±4.5°(0 to 15°)

3.2±2.1°(0 to 5°)

Induced Corneal Astigmatism

0.56±0.21 D(0.25 to 0.75 D)

0.21±0.14 D(0.0 to 0.32 D)

Group 1 Group 2

Group 1 Group 2

Twice Better Alignment of the Lenses in Group 2.

Twice Less Corneal Astigmatism Induced in Group 2

NO T-ICL Rotation in Any Group of PatientsNO T-ICL Rotation in Any Group of PatientsNO T-ICL Rotation in Any Group of PatientsNO T-ICL Rotation in Any Group of Patients

Conclusions:

Toric ICL are safe and effective for correction of High Myopic Astigmatism.

Limbal (versus Clear Corneal) tunnels are more astigmatically neutral.

Preoperative meticulous marking of the axis under SL facilitates more accurate alignment of the lenses.

T-ICLs have very good rotational stability.