Let’s review a routine case, this time with a toric IOL. All surgeons in training must know how to properly load the IOL for their surgery. Having a surgical assistant load the IOL is only acceptable once you have mastered this maneuver yourself.
The first thing is that the surgeon is loading the toric IOL into the injector because the new scrub technician is used to only the pre-loaded IOLs and she is still learning how to load these types of IOLs. This is a good opportunity to review again the technique of loading a single-piece acrylic IOL into the injector, something which we have previously covered here.
The other helpful review is to remember that astigmatism is a vector, and as such it has both magnitude and direction. The steep axis of astigmatism on the cornea is at about 100° which means that ideally the phaco incision should be placed in such a manner that this stays precisely at 100° even if the magnitude changes. If we place the incision right at 100° then it would help reduce the astigmatism. Instead, we want to sit and operate form the temporal position and that means that we should make the incision at 190° which is the same as 10° because this will not change the direction of the astigmatism, but rather it will just slightly increase the magnitude. And we an easily account for that by increasing the toric power correction that is on the IOL.
Watch the video for the complete review and annotation. It is helpful to review these routine, normal cases because that is what you will see in your clinic the most often.
Click below to start the video and see the details of the surgery:
