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• W3162072549 abstract "We discussed the article by Haripriya et al. comparing surgical repositioning rates between the AcrySof hydrophobic and Auroflex hydrophilic monofocal toric intraocular lenses (IOLs), as part of the ESCRS Eye Journal Club.1,2 We congratulate the authors on their work, describing the largest published cohort of patients implanted with hydrophilic toric IOLs. However, we would like to highlight some assumptions made in the study that relate directly to its primary aim (ie, the effect of IOL material on rotational stability) and aspects of methodology that may affect its interpretation. We would caution against the assumption that the AcrySof SN6AT hydrophobic (Alcon Laboratories, Inc.) and Auroflex FH560 hydrophilic (Aurolab) monofocal toric IOLs differed only in the polarity of the acrylic from which they are manufactured. The hydrophobic IOL has a 13.0 mm overall diameter for all cylindrical and spherical powers with single-arm loop haptics, whereas the hydrophilic IOL has an overall length of 12.0 mm for 18.50 to 30.00 diopter (D) models and 12.5 mm for 10.00 to 18.00 D models with bulkier closed-loop dual haptics. Differences in haptic design and length4 have been shown to independently influence rotational stability of an IOL, which may represent confounding factors between the 2 groups.3,4 The variation in surgical marking techniques prior to toric IOL implantation between studies and within studies is a likely source of error in the evaluation of postoperative rotational stability. Systematic differences in the accuracy of corneal axis marking have been shown between different methods.5 Moreover, it is likely that intersurgeon variability may exist in the accuracy and reproducibility of manual corneal axis markings. Video capture at the conclusion of surgery may distinguish preoperative or intraoperative errors (ie, misalignment due to inaccurate corneal axis marking or errors in IOL alignment) from postoperative IOL rotation.3 In this regard, it is useful to highlight that the study primarily assessed axis misalignment rather than postoperative rotation between the IOL groups. The large rotational deviation (mean 50.2 degrees and 47.5 degrees for each group undergoing repositioning surgery) is far higher than that in other similar studies, implying that the axis misalignment may be heavily influenced by factors other than postoperative IOL rotation. Moreover, in Table 1, at least 3 individuals had 85 to 90 degrees of axis misalignment, suggesting possible confusion between maximum and minimum keratometry values (ie, Kmax and Kmin). The surgical repositioning rate reported (1.5% and 1.8%, respectively) seems low given the degree of misalignment in those who underwent repositioning surgery, considering that surgery was offered for those with more than 15 degrees of misalignment. If studies presented postoperative IOL misalignment data as a histogram according to the degree of rotation (ie, in the 5-degree bins), this would allow a more objective comparison between studies. Even if criteria for repositioning were standardized across studies, there may be socioeconomic factors that might influence the decision to proceed to surgery; Oshika et al. reported a lower degree of mean axis misalignment (26.4 ± 21.9 degrees) in those undergoing repositioning surgery with the AcrySof monofocal toric IOL, although this is far higher than that is typically reported in the European or U.S. settings.6" @default.
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• W3162072549 date "2021-06-01" @default.
• W3162072549 modified "2023-10-14" @default.
• W3162072549 title "Comment on: Comparison of surgical repositioning rates and outcomes for hydrophilic vs hydrophobic single-piece acrylic toric IOLs" @default.
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• W3162072549 doi "https://doi.org/10.1097/j.jcrs.0000000000000682" @default.
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