A Simple, Inexpensive, and Precise Photographic Method for Intraoperative Toric IOL Alignment

Heinrich Gerding, G. M. Somfai, Marco Langenegger

Research output: Contribution to journalArticle


Background It was the aim of this study to analyse the refractive outcome of toric intraocular lens (t-IOL) implantation guided by a newly developed method of photographic alignment. Material and Methods Fourteen eyes of 10 patients (6 females, 4 males, age 63.4 ± 6.7 (40.6-68.0) years [mean ± 1 SD (range)]) were included in this retrospective study. All eyes received an Oculentis Tplus LS-313 (Oculentis, Berlin, Germany) t-IOL after standard phacoemusification (n = 4) or femtocataract laser-assisted surgery (n = 10). Image-guided t-IOL alignment included: (1) calculation of t-IOL parameters (combination of different biometric methods) and plotting a layout drawing of the target lens position, (2) capture of an anterior segment slit lamp photograph in the upright position, (3) superposition of the photographs by the t-IOL target plot and a gradual scale, (4) drawing of marker lines on the photograph and removal of the IOL target coordinates, (5) transfer of the final image to a tablet PC, and (6) marking of the target axis at the corneal limbus with an ink pen in the surgical room. Results Preoperative corneal astigmatism was 2.50 ± 0.97 (1.38-4.34) diopters (D) (mean ± 1 SD, range). In all eyes, intraoperative alignment could easily be performed using the photographic target layout. Surgical interventions and postoperative follow-up were without complications in all cases. Residual postoperative astigmatism was 0.16 ± 0.24 (0.00-0.75) D (p < 0.001 compared to preoperative astigmatism). In 64% of patients, residual subjective astigmatism was zero, in 93% ≤ 0.5 D, and in 100% ≤ 0.75 D. Postoperative uncorrected logMAR visual acuity (0.05 ± 0.07, range 0.00-0.20) and best-corrected visual acuity (0.03 ± 0.05, 0.00-0.10) were significantly better (each p < 0.001) than best-corrected preoperative visual acuity (0.21 ± 0.14, 0.00-0.49). Conclusions Results of this clinical series clearly indicate that the newly developed photographically guided technique of toric lens alignment leads to highly accurate postoperative results for astigmatic correction.

Original languageEnglish
Pages (from-to)391-397
Number of pages7
JournalKlinische Monatsblatter fur Augenheilkunde
Issue number4
Publication statusPublished - Jan 1 2019


  • aberrometry
  • astigmatism
  • cornea
  • intraocular lens
  • IOL
  • keratometry
  • lens alignment
  • toric intraocular lenses

ASJC Scopus subject areas

  • Ophthalmology

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