Acri.LISA Toric 466 TD: a multitalented IOL

Ophthalmic surgeons have been implanting multifocal lenses for several years, not only in cataract surgery, but also to offset the accommodation lost as a consequence of age. With the newest generation of lenses, more than 80% of refractive and cataract patients can now enjoy life without glasses.

The degree of patient satisfaction after multifocal lens implantation does, however, depend on whether exact emmetropy is obtained postoperatively; in up to 15% of cases, it is necessary to perform an additional refractive surgery procedure for the remaining ametropy in order to achieve this. Specifically, the bioptics approach is required and the procedure of choice is LASIK.

The IOL can be implanted through a 1.5 mm incision and it does not induce any further astigmatism surgically, which is very advantageous for successful toric and refractive surgery. The new diffractive design also enables optimal optical imaging quality without diffused light.

Another requirement, which must be fulfilled particularly by a toric IOL model, is good postoperative rotational stability. Reiter et al.¹ showed no significant lens rotation (>4°) in 98% of cases six months postoperatively for the Acri.Smart 46, which is the basic model of the toric IOL. Meanwhile, Wehner² found neither rotation nor decentration with the same IOL model after 12 to 19 months.

The case study

A 44-year-old woman came to us desiring a LASIK procedure. She suffered myopia and astigmatism, and the early stages of presbyopia were also evident. We rejected a refractive procedure because of the keratoconus internus in her right eye. Distance vision preoperative in the right eye was -1.75-4.75/158° = 20/30 BCVA and in the left -4.54.0/4°= 20/40 BCVA.