Enhancing visibility and efficiency in toric intraocular lens surgery with the pivot technique and an assistant-mounted guidance system.

PURPOSE: 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.

SETTING

ASUCA Eye Clinic, Sendai, Miyagi, Japan.

DESIGN

Experimental study and retrospective observational study.

METHODS

The influence of the Verion guidance system on surgical field image quality was evaluated in porcine eyes through luminance analysis in ImageJ. The clinical study included 201 eyes with grade 2 nuclear cataracts. Axis marking was performed 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 postoperatively. Secondary outcomes included surgical time, visual acuity, and refractive results.

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 seconds vs 233.6 ± 119.2 seconds; P = .024). Postoperative visual and refractive outcomes were comparable ( P > .05) with no serious complications.

CONCLUSIONS

The pivot technique achieved comparable IOL rotational stability and visual outcomes vs 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.