ピボット法とアシスタントマウント型ガイダンスシステムを用いた乱視用眼内レンズ手術における視認性と効率の向上

To evaluate surgical outcomes and visibility when mounting the Verion guidance system on the assistant microscope compared with the main microscope during toric intraocular lens (IOL) implantation.

ASUCA Eye Clinic, Sendai, Miyagi, Japan.

Experimental study and retrospective observational study.

The influence of the Verion guidance system on surgical field image quality was evaluated in porcine eyes via luminance analysis in ImageJ. The clinical study included 201 eyes with grade 2 nuclear cataracts. Axis marking was done with the guidance system mounted on the assistant microscope using the Pivot technique (Pivot group; n = 105) or on the main microscope using the conventional technique (Conventional group; n = 96). The primary outcome was IOL rotational stability at 3 months post-operatively. Secondary outcomes included surgical time, visual acuity, and refractive results.

The guidance system significantly reduced overall image brightness (mean luminance: 55.4 ± 15.4 vs. 84.8 ± 17.7) and obscured fine details. The Pivot and Conventional groups had no significant difference in absolute toric IOL misalignment at 3 months (P = .819). Surgical time was shorter in the Pivot group (226.8 ± 105.4 s vs. 233.6 ± 119.2 s; P = .024). Postoperative visual and refractive outcomes were comparable (P > .05) with no serious complications.

The Pivot technique achieved comparable IOL rotational stability and visual outcomes versus the conventional method. By circumventing light reduction induced by the guidance system, the Pivot technique represents a safe, useful, and efficient alternative in toric IOL implantation.