With increased patient expectations for precise post-operative refractive results, the need for accurate keratometry, biometry, and appropriate intraocular lens power formula selection is of paramount importance. The past decade has brought improvements in topography, biometry, and intraocular lens (IOL) calculations and the advent of intra-operative imaging and aberrometry has assisted in achieving more accurate post-surgical refractive outcomes. This review aims to provide an overview of imaging modalities used in the pre-operative and intra-operative setting in anterior segment cataract surgery. Intraoperative imaging can be used in: capsulorhexis centration, wound and astigmatic keratometry placement, IOL centration and toric alignment. Specifically, we aim to provide an overview on the Zeiss Callisto® (Zeiss, Oberkochen, Germany) imaging system used in toric lens alignment, the Alcon Verion (Alcon, Fort Worth, Texas, USA) used in combination with the ORA SystemTM (WaveTec Vision, Aliso Viejo, California, USA) for toric lens alignment and intraoperative aberrometry for lens selections, and the TrueVision 3D System (TrueVision 3D Surgical, Goleta, CA, USA) used in toric lens alignment. The utility of intraoperative imaging in correcting astigmatism and selecting IOL powers in routine cataract surgery remains an adjuvant to current pre-operative keratometry and biometry. Although studies have shown effectiveness of utilising intraoperative imaging in cataract surgery, there remains a need for larger retrospective studies that compare the accuracy of current IOL formulas versus intraoperative aberrometry in both normal and post-refractive surgery.
Cataract, toric alignment, intraoperative imaging, lens
Zaina Al-Mohtaseb is a financial consultant to Alcon, Johnson & Johnson and Zeiss. Mahmood Khan has nothing to declare in relation to this article.
Double-blind peer review.
The named authors meet the International Committee of Medical Journal Editors (ICMJE) criteria for authorship of this manuscript, take responsibility for the integrity of the work as a whole, and have given final approval for the version to be published.
Zaina Al-Mohtaseb, Cullen Eye Institute, Department of Ophthalmology, Baylor College of Medicine, 6565 Fannin St, Houston, TX 77030, US. E: firstname.lastname@example.org
No funding was received in the publication of this article.
14 October 2019
Share this Article
Related Content In Cataract Surgery
Foreword – US Ophthalmic Review Fall 2020
Welcome to the latest edition of US Ophthalmic Review, which aims to review topical subjects in the field of ophthalmology. This edition features a wide range of articles that evaluate current practices and research, as well as discussing future directions and innovations that directly affect ophthalmologists. We begin with an article on corneal cross-linking (CXL). The […]
Pearls for Addressing Brunescent Cataracts
US Ophthalmic Review. 2020;13(1):14–5 DOI: https://doi.org/10.17925/USOR.2020.13.1.14
Brunescent, or brown, cataracts are found in advanced cataracts and can cause decreased visual acuity, with poor contrast and color discrimination, especially at the blue end of the visible light spectrum.1 They are particularly challenging to treat due to the increased nuclear density, and surgery is associated with a higher rate of complications compared with other […]
Clear Lens Extraction in Primary Angle-Closure Disease—Pros and Cons
US Ophthalmic Review. 2020;13(1):23–9 DOI: https://doi.org/10.17925/USOR.2020.13.1.23
Recently, new surgical modalities for management of primary angle-closure disease (PACD) have been proposed; the most controversial of which being clear lens extraction (CLE). The Effectiveness in Angle-closure Glaucoma of Lens Extraction (EAGLE) and other studies recommend CLE as the primary procedure of choice to manage eyes with PACD.1–5 However, the rationale for CLE without resorting […]
Journal articles and more to your inbox
Get the latest clinical insights from touchOPHTHALMOLOGYSign me up!