Clinical trial NCT02412215: Rotational Stability After Nanoflex Collamer Toric Intraocular Lens Implantation in Astigmatic Patients
Official title: Rotational Stability After Nanoflex Collamer Toric Intraocular Lens Implantation in Astigmatic Patients Undergoing Cataract Surgery
Study type: INTERVENTIONAL
Overall status: UNKNOWN
Phase: NA
Conditions: Astigmatism
Lead sponsor: University of Turin, Italy
Sponsor class: OTHER
First posted: 2015-04-09
Enrollment: 60
Sex: ALL
Minimum age (years): 60
Standard ages: ADULT
OLDER_ADULT
Accepts healthy volunteers: no
Allocation: NA
Intervention model: SINGLE_GROUP

Brief summary: This study aims to assess the rotational stability of the new collameric Nanoflex toric intraocular lens (T-IOL) by STAAR inserted in astigmatic patients after cataract surgery.

The purpose of this study is also to determine whether the use of a toric intraocular lens (T-IOL) improves visual acuity.

Detailed description: A good rotational stability of toric intraocular lenses (T-IOL) allows an accurate refractive correction. However, many aspects -both pre-operative and post-operative- can interfere causing T-IOL rotation and misalignment.

Complete preoperative ocular evaluation is performed including slit-lamp examination, uncorrected distance visual acuity (UDVA), best-corrected visual acuity (BCVA), Javal keratometry, corneal Scheimplug tomography (Pentacam), optical biometry (IOL Master), Goldman applanation tonometry and fundus evaluation through dilated pupils. The spherical IOL power is calculated considering the axial length obtained with optical biometry, the magnitude of astigmatism derived from Javal keratometry and the steepest axis obtained with corneal tomography. The power of the toric IOL is determined with the online Staar Toric IOL calculator. The reference landmarks are also marked preoperatively with a sterile methylene blue fine point pen. The marking is rechecked in the operating theatre with the electronic toric marker ASICO.

Postoperative evaluation for IOL alignment and rotational stability is performed with slit-lamp photography on dilated pupils. Images are captured with Haag Streit slit lamp BQ 900 and are evaluated with the image-analysis software Protractor (Staar).

Eligibility criteria: Inclusion Criteria:

* Patients of 60 years of age ore more
* Cataract
* Corneal astigmatism of 1 diopter (D) or more

Exclusion Criteria:

* Primary or secondary pathological conditions of the cornea
* Zonular fibres pathologies (phacodonesis, pseudoexfoliation syndrome)
* Irregular astigmatism (corneal scar, keratoconus, pterygium)
* Traumatic cataract
* Previous ocular surgery
* Complications during cataract surgery

Primary outcomes:
measure: Change in rotational stability of the toric intraocular lens (T-IOL).
timeFrame: Change of rotational stability at 1 day, 1 week, 1 month, 3 months, 6 months, 12 months and 18 months after surgery.
Secondary outcomes:
measure: Correction of the astigmatism.
timeFrame: Change in visual acuity at 1 day, 1 week, 1 month, 3 months, 6 months, 12 months and 18 months after surgery
Other outcomes:
Locations:
city: Turin
country: Italy
facility: Ophthalmology Institute, University of Turin
Study officials:
affiliation: Department of Surgical Sciences, Ophthalmology Institute, University of Turin
name: Antonio M Fea, MD, PhD
role: PRINCIPAL_INVESTIGATOR
References:
citation: Ferrer-Blasco T, Montes-Mico R, Peixoto-de-Matos SC, Gonzalez-Meijome JM, Cervino A. Prevalence of corneal astigmatism before cataract surgery. J Cataract Refract Surg. 2009 Jan;35(1):70-5. doi: 10.1016/j.jcrs.2008.09.027.
citation: Rashad KM. Laser in situ keratomileusis for myopic astigmatism. J Refract Surg. 1999 Nov-Dec;15(6):653-60. doi: 10.3928/1081-597X-19991101-09.
citation: Novis C. Astigmatism and toric intraocular lenses. Curr Opin Ophthalmol. 2000 Feb;11(1):47-50. doi: 10.1097/00055735-200002000-00007.
citation: Chang DF. Early rotational stability of the longer Staar toric intraocular lens: fifty consecutive cases. J Cataract Refract Surg. 2003 May;29(5):935-40. doi: 10.1016/s0886-3350(02)01843-6.
citation: Lane SS, Burgi P, Milios GS, Orchowski MW, Vaughan M, Schwarte E. Comparison of the biomechanical behavior of foldable intraocular lenses. J Cataract Refract Surg. 2004 Nov;30(11):2397-402. doi: 10.1016/j.jcrs.2004.03.041.
citation: Lombardo M, Carbone G, Lombardo G, De Santo MP, Barberi R. Analysis of intraocular lens surface adhesiveness by atomic force microscopy. J Cataract Refract Surg. 2009 Jul;35(7):1266-72. doi: 10.1016/j.jcrs.2009.02.029.
citation: Lane SS, Ernest P, Miller KM, Hileman KS, Harris B, Waycaster CR. Comparison of clinical and patient-reported outcomes with bilateral AcrySof toric or spherical control intraocular lenses. J Refract Surg. 2009 Oct;25(10):899-901. doi: 10.3928/1081597X-20090617-05. Epub 2009 Oct 12.
citation: Koshy JJ, Nishi Y, Hirnschall N, Crnej A, Gangwani V, Maurino V, Findl O. Rotational stability of a single-piece toric acrylic intraocular lens. J Cataract Refract Surg. 2010 Oct;36(10):1665-70. doi: 10.1016/j.jcrs.2010.05.018.
citation: Entabi M, Harman F, Lee N, Bloom PA. Injectable 1-piece hydrophilic acrylic toric intraocular lens for cataract surgery: efficacy and stability. J Cataract Refract Surg. 2011 Feb;37(2):235-40. doi: 10.1016/j.jcrs.2010.08.040.
citation: Visser N, Bauer NJ, Nuijts RM. Toric intraocular lenses: historical overview, patient selection, IOL calculation, surgical techniques, clinical outcomes, and complications. J Cataract Refract Surg. 2013 Apr;39(4):624-37. doi: 10.1016/j.jcrs.2013.02.020.
citation: Shimizu K, Misawa A, Suzuki Y. Toric intraocular lenses: correcting astigmatism while controlling axis shift. J Cataract Refract Surg. 1994 Sep;20(5):523-6. doi: 10.1016/s0886-3350(13)80232-5.
citation: Till JS, Yoder PR Jr, Wilcox TK, Spielman JL. Toric intraocular lens implantation: 100 consecutive cases. J Cataract Refract Surg. 2002 Feb;28(2):295-301. doi: 10.1016/s0886-3350(01)01035-5.
citation: Dick HB, Krummenauer F, Trober L. [Compensation of corneal astigmatism with toric intraocular lens: results of a multicentre study]. Klin Monbl Augenheilkd. 2006 Jul;223(7):593-608. doi: 10.1055/s-2006-926652. German.
citation: Stewart CM, McAlister JC. Comparison of grafted and non-grafted patients with corneal astigmatism undergoing cataract extraction with a toric intraocular lens implant. Clin Exp Ophthalmol. 2010 Nov;38(8):747-57. doi: 10.1111/j.1442-9071.2010.02336.x.
citation: Chang DF. Comparative rotational stability of single-piece open-loop acrylic and plate-haptic silicone toric intraocular lenses. J Cataract Refract Surg. 2008 Nov;34(11):1842-7. doi: 10.1016/j.jcrs.2008.07.012.
citation: Alio JL, Agdeppa MC, Pongo VC, El Kady B. Microincision cataract surgery with toric intraocular lens implantation for correcting moderate and high astigmatism: pilot study. J Cataract Refract Surg. 2010 Jan;36(1):44-52. doi: 10.1016/j.jcrs.2009.07.043.
citation: Bachernegg A, Ruckl T, Riha W, Grabner G, Dexl AK. Rotational stability and visual outcome after implantation of a new toric intraocular lens for the correction of corneal astigmatism during cataract surgery. J Cataract Refract Surg. 2013 Sep;39(9):1390-8. doi: 10.1016/j.jcrs.2013.03.033. Epub 2013 Jul 2.
citation: Bascaran L, Mendicute J, Macias-Murelaga B, Arbelaitz N, Martinez-Soroa I. Efficacy and stability of AT TORBI 709 M toric IOL. J Refract Surg. 2013 Mar;29(3):194-9. doi: 10.3928/1081597X-20130129-02.
citation: Chassain C. [Evaluation of visual performance after implantation of a double C-Loop toric intraocular lens]. J Fr Ophtalmol. 2014 Sep;37(7):507-13. doi: 10.1016/j.jfo.2014.02.007. Epub 2014 Aug 13. French.
citation: Waltz KL, Featherstone K, Tsai L, Trentacost D. Clinical outcomes of TECNIS toric intraocular lens implantation after cataract removal in patients with corneal astigmatism. Ophthalmology. 2015 Jan;122(1):39-47. doi: 10.1016/j.ophtha.2014.06.027. Epub 2014 Nov 18.
citation: Nguyen TM, Miller KM. Digital overlay technique for documenting toric intraocular lens axis orientation. J Cataract Refract Surg. 2000 Oct;26(10):1496-504. doi: 10.1016/s0886-3350(00)00442-9.
citation: Rozema JJ, Gobin L, Verbruggen K, Tassignon MJ. Changes in rotation after implantation of a bag-in-the-lens intraocular lens. J Cataract Refract Surg. 2009 Aug;35(8):1385-8. doi: 10.1016/j.jcrs.2009.03.037.
citation: Weinand F, Jung A, Stein A, Pfutzner A, Becker R, Pavlovic S. Rotational stability of a single-piece hydrophobic acrylic intraocular lens: new method for high-precision rotation control. J Cataract Refract Surg. 2007 May;33(5):800-3. doi: 10.1016/j.jcrs.2007.01.030.
citation: Shah GD, Praveen MR, Vasavada AR, Rampal NV, Vasavada VA, Asnani PK, Pandita D. Software-based assessment of postoperative rotation of toric intraocular lens. J Cataract Refract Surg. 2009 Mar;35(3):413-8. doi: 10.1016/j.jcrs.2008.10.057.
citation: Cha D, Kang SY, Kim SH, Song JS, Kim HM. New axis-marking method for a toric intraocular lens: mapping method. J Refract Surg. 2011 May;27(5):375-9. doi: 10.3928/1081597X-20101005-01. Epub 2010 Oct 15.
citation: Sanders DR, Sarver EJ, Cooke DL. Accuracy and precision of a new system for measuring toric intraocular lens axis rotation. J Cataract Refract Surg. 2013 Aug;39(8):1190-5. doi: 10.1016/j.jcrs.2013.06.006.
citation: Patel CK, Ormonde S, Rosen PH, Bron AJ. Postoperative intraocular lens rotation: a randomized comparison of plate and loop haptic implants. Ophthalmology. 1999 Nov;106(11):2190-5; discussion 2196. doi: 10.1016/S0161-6420(99)90504-3.
citation: Chua WH, Yuen LH, Chua J, Teh G, Hill WE. Matched comparison of rotational stability of 1-piece acrylic and plate-haptic silicone toric intraocular lenses in Asian eyes. J Cataract Refract Surg. 2012 Apr;38(4):620-4. doi: 10.1016/j.jcrs.2011.10.037. Epub 2012 Jan 31.
citation: Prinz A, Neumayer T, Buehl W, Vock L, Menapace R, Findl O, Georgopoulos M. Rotational stability and posterior capsule opacification of a plate-haptic and an open-loop-haptic intraocular lens. J Cataract Refract Surg. 2011 Feb;37(2):251-7. doi: 10.1016/j.jcrs.2010.08.049.
citation: Mamalis N, Omar O, Veiga J, Tanner D, Pirayesh A, Fernquist DS. Comparison of two plate-haptic intraocular lenses in a rabbit model. J Cataract Refract Surg. 1996;22 Suppl 2:1291-5. doi: 10.1016/s0886-3350(96)80087-3.
citation: Sacu S, Findl O, Linnola RJ. Optical coherence tomography assessment of capsule closure after cataract surgery. J Cataract Refract Surg. 2005 Feb;31(2):330-6. doi: 10.1016/j.jcrs.2004.04.057.
citation: Kim MH, Chung TY, Chung ES. Long-term efficacy and rotational stability of AcrySof toric intraocular lens implantation in cataract surgery. Korean J Ophthalmol. 2010 Aug;24(4):207-12. doi: 10.3341/kjo.2010.24.4.207. Epub 2010 Aug 3.
citation: Gomez-Bastar A, Jaimes M, Graue-Hernandez EO, Ramirez-Luquin T, Ramirez-Miranda A, Navas A. Long-term refractive outcomes of posterior chamber phakic (spheric and toric implantable collamer lens) intraocular lens implantation. Int Ophthalmol. 2014 Jun;34(3):583-90. doi: 10.1007/s10792-013-9860-1. Epub 2013 Oct 11.