How to plan for your first multi-focal, toric IOL
It is a good option, if the patient has more than 0.75 D CORNEAL astigmatism. He should have a strong desire to have good vision without spectacles. Those who are happy wearing glasses, should be left to do that!
You should be sure of your surgeon induced astigmatism, and that you can land at target Emmetropia post surgery. It is best to do few multifocals and calculate the surgeons A constant.
The axis of astigmatism should be marked in sitting posture, and I think the most popular method now is free hand marking! You could use YAG laser to mark the corneal horizontal meridian, with the guidance of the horizontally place slit on a slit lamp. the head should be vertically straight! The chart for toric IOL implantation should be next to you, alligned in the same direction as patients head, so that mistakes dont happen!
The loops should be few degrees away from the direction of IOL rotation before removing all the visco from behind and in front of AC. Just before coming out, bring the IOL to the correct alignment. Also, you can align the centre of innermost ring to the corneal Purkinje image.
The patient should be informed about the rings around light at night.
Routinely do a Pentacam HR and OCT macula & Specular microscopy before implanting any premium IOLs. If there is an asymetrical corneal astigmatism, any kind of macular lesion and in lower endothelial counts, avoid them.
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