None of the authors has a financial interest on the presented data. ASCRS Boston 2010 Residual astigmatism after multifocal IOL implantation: prediction and possible management Authors: Eva Vyplasilova, MD Katerina Buusova Smeckova, MD, MBA As. proff. Zdenek Smecka, MD, CSc. Klinika ocni a esteticke chirurgie in Zlin Czech Republic None of the authors has a financial interest on the presented data.

Aim Methods evaluation the satisfaction with unilateral and bilateral UCVA in patients after implantation of AcrySof ReSTOR +3 IOL. prediction of the final refraction (mainly Dcyl) and overall patient satisfaction. determination the amount of dioptries when patients usually request a laser enhancement findning recommendations about suitable procedures to be chosen. Dissatisfaction with optical phenomenons like halo, glare, speed of focusing, eye dryness and surgery or speed of recovery were not taken into account. Preoperative BCVA, autorefractometry values and corneal astigmatism values from the IOL Master were measured. Lens clearness and pathologies were evaluated. Standard cataract / RLE surgery was performed-Infinity phaco, incision 2,2mm, one surgeon, in the case of the higher astigmatism incision in the K max, no relaxation incisions. Postoperatively was evaluated mono- and binocular UCVA, autorefractometry values, requests for glasses prescription, patient subjective satisfaction and laser enhancement rate- how many were requested and performed. ASCRS Boston 2010

Setting / Venue ASCRS Boston 2010

Results: Refraction: 0,33 Dsf +/- 0,48 [-1,5; +2,50] 0,50 Dcyl +/- 0,79 [-5; 0] SE: 0,7 +/- 0,56 [-2,5; +2,6] UCVA: 0,83 [0,2; 1,5] Subjective satisfaction: satisfied: 390 eyes 77 % parctially satisfied: 95 eyes 19% of eyes unsatisfied: 23 eyes 4% In 77% of cases was the astigmatism decreased,unchanged or increased by no more than 0,1Dcyl. ASCRS Boston 2010

Results- prediction of astigmatism Group 0-0,5 Dcyl Residual astigmatism Preoperative on the average: O,33 Dcyl 0,39 Dcyl [0; 1,25] Postperative on the average: 55% or unchanged x 45% (max. by 0,75Dcyl) ASCRS Boston 2010

Results- prediction of astigmatism Group 0,5- 1,0 Dcyl Residual astigmatism Preoperative on the average: O,74 Dcyl 0,54 Dcyl [0; 1,75] Postperative on the average: 82% or unchanged x 18% ASCRS Boston 2010

Results- prediction of astigmatism Group 1,0– 1,5 Dcyl Residual astigmatism Preoperative on the average: 1,20 Dcyl 0,71 Dcyl Postperative on the average: 92% or unchanged x 8% ASCRS Boston 2010

Results- prediction of astigmatism Group 1,5 Dcyl and more Residual astigmatism Preoperative on the average: 2,50 Dcyl 1,9 Dcyl Postperative on the average: 86% or unchanged x 14% ASCRS Boston 2010

ASCRS Boston 2010

ASCRS Boston 2010

Comparison with other means of correcting astigmatism ASCRS Boston 2010

Conclusion 80% of patients had post-operative astigmatism equal or better, so it is quite predictable. We recommend to tailor the solution upon the pre-operative corneal astigmatism. When pre-operative corneal astigmatism is higher than 1,0Dcyl, enhancement is highly possible. When more than 1,5Dcyl is measured, enhancement or other correction means (toric IOL) should be planned. Toric multifocal IOLs are technically very complex and according to our experience there might be a problem with their prediction and sometimes the dispersion in sphere or cylinder may be as high as 1,5D, When the result with toric MIOL is not perfect, enhancement is necessary and this modality increases costs for the clinic and patients are often distempered. That's why we prefer the alternative of MIOL followed by laser enhancement. The main disadvantage are 2 surgeries, but the result is precise.