title: Toric Implantable Collamer Lens for moderate to high myopic astigmatism.
abstract: OBJECTIVE
  To assess the efficacy of the Toric Implantable Collamer Lens (ICL) to treat moderate to high myopic astigmatism.
  
  
  METHODS
  Prospective nonrandomized clinical trial.
  
  
  METHODS
  Two hundred ten eyes of 124 patients with between 2.38 and 19.5 diopters (D) of myopia (spherical equivalent [SE]) and 1 to 4 D of astigmatism participating in the United States Food and Drug Administration clinical trial of the Toric ICL.
  
  
  METHODS
  Implantation of the Toric ICL.
  
  
  METHODS
  Uncorrected visual acuity (UCVA), refraction, best spectacle-corrected visual acuity (BSCVA), adverse events, and postoperative complications.
  
  
  RESULTS
  At 12 months postoperatively, the proportion of eyes with 20/20 or better UCVA (83.1%) was identical to the proportion of eyes with preoperative 20/20 or better BSCVA (83.1%); 76.5% had postoperative UCVA better than or equal to preoperative BSCVA. The mean manifest refractive cylinder dropped from 1.93 D (+/-0.84) at baseline to 0.51 D (+/-0.48) postoperatively, a 73.6% decrease in astigmatism. Although only 21.0% of eyes had 1-D refractive cylinder preoperatively (none less), 91.4% of cases had < or =1 D of cylinder postoperatively. Furthermore, 65.6% had < or =0.5 D and 40.9% had < or =0.25 D of refractive cylinder postoperatively. Mean manifest refraction SE (MRSE) improved from -9.36 D (+/-2.66) preoperatively to 0.05 D (+/-0.46) postoperatively. A total of 76.9% of eyes were predicted accurately to within +/-0.5 D, 97.3% to within +/-1.0 D, and 100% to within +/-2.0 D of predicted MRSE. Postoperatively, 37.6% of eyes had a BSCVA of 20/12.5 or better, compared with a preoperative level of 4.8%. Furthermore, BSCVA of 20/20 or better occurred in 96.8% postoperatively, compared with 83.1% preoperatively. Mean improvement in BSCVA was 0.88 lines; there were 3 cases (1.6%) that lost > or =2 lines of BSCVA after 12 months postoperatively, whereas 18.9% of cases improved by > or =2 lines. A total of 76.4% of cases gained > or =1 lines of BSCVA, whereas only 7.5% of cases lost the equivalent amount. Three ICL removals were performed without significant loss of BSCVA, and 1 clinically significant lens opacity was observed.
  
  
  CONCLUSIONS
  The results support the efficacy and predictability of Toric ICL implantation to treat moderate to high myopic astigmatism. Important safety concerns were not identified.
authors.affiliation: Department of Ophthalmology, University of Illinois at Chicago College of Medicine, Chicago, Illinois, USA.
authors.forename: Donald R
authors.initials: DR
authors.lastname: Sanders
authors.forename: David
authors.initials: D
authors.lastname: Schneider
authors.forename: Robert
authors.initials: R
authors.lastname: Martin
authors.forename: David
authors.initials: D
authors.lastname: Brown
authors.forename: David
authors.initials: D
authors.lastname: Dulaney
authors.forename: John
authors.initials: J
authors.lastname: Vukich
authors.forename: Stephen
authors.initials: S
authors.lastname: Slade
authors.forename: Steven
authors.initials: S
authors.lastname: Schallhorn
mesh_terms: D000328:Adult; D001251:Astigmatism / Q000601:surgery*; D005260:Female; D006801:Humans; D019654:Lens Implantation, Intraocular; D007908:Lens, Crystalline / Q000502:physiology; D007910:Lenses, Intraocular; D008297:Male; D008875:Middle Aged; D009216:Myopia / Q000601:surgery*; D017060:Patient Satisfaction; D011183:Postoperative Complications; D011446:Prospective Studies; D012029:Refraction, Ocular / Q000502:physiology; D016896:Treatment Outcome; D014792:Visual Acuity / Q000502:physiology