Clinical outcomes, astigmatism-
correction and rotational stability
after the implantation of the
Medicontur Bi-flex 677TAY
toric intraocular lens
MuDr. Iveta Nemcova
Klinické Centrum ISCARE
Holešovice, Čechy
87% 65% 22%
87% of cataract surgery patients
had preoperative astigmatism
In 65%, corneal astigmatism was
between 0.25 and 1.25 D
22% of eyes had astigmatism
greater than 1.50 D
According to many demographics studies most patients with cataract have corneal astigmatism as well.
The study by Ferrer-Blasco including 4,540 eyes has reported, that:
Ferrer-Blasco T, Montés-Micó R, Peixoto-de-Matos SC, González-Méijome JM, Cerviño A. Prevalence of corneal astigmatism before cataract
surgery. J Cataract Refract Surg. 2009;35(1):70-5.
Astigmatism in cataract patients
3
1. Spectacles and contact lenses
2. Limbal Relaxing Incisions (LRI)
3. Laser correction surgeries
4. Corneal ring
5. Intraocular lenses (toric, cylindric)
Astigmatism - Correction
Experiences with the
Medicontur Bi-Flex 677TAY
toric IOLs
A prospective study including
22 patients (35 eyes)
Study design
• Prospective, non-comparative
• 22 patients → 35 eyes (mono- or binocular implantation)
• Conventional cataract surgery (phacoemulsification followed by monofocal toric IOL implantation)
- In case of binocular surgery, the fellow eye was implanted XX weeks after the surgery of
the first eye
• Follow-up visits:
• Measurements, examinations (both pre- and postop.)
- Visual acuity (UCDVA, BCDVA, BCNVA)
- Autorefractometry
- IOP
- IOL position
- Biometry (preop.)
Preop Day 1 Day 7 Month 2Month 1 Month 3
• E X C E L L E N T R O TAT I O N AL S TAB I L I T Y
- Stable also in long eyes (25< mm)
• L O W P C O R AT E
- Perfect 360° SE (<10um)
• W I D E S T C Y L I N D R I C AL R AN G E
- Concave-convex technology
• O P T I M AL C O N T R A S T S E N S I T I V I T Y
- Low chromatic aberration
- Natural yellow filter
• P R E L O AD E D M O D E L
• T h e M E D I C O N T U R I O L O P T I M I Z E R
- Haigis + Abulafia-Koch Formula, taking full
corneal power into consideration
H Y D R O P H I L I C A C R Y L I C , M O N O F O C A L T O R I C I O L
Bi-Flex 677TAY IOL by Medicontur
h t t p s : / / t o r i c c a l c u l a t o r . n e t / # / m a i n
P R O D U C T S P E C I F I C A T I O N S
Bi-flex 677TAY IOL by Medicontur
Demographic of the patients
Demographic Mean ± SD Range
Age (y) 67.0 ± 4.5 58 - 74
Gender (n)
Female 14 (63.6%)
Male 8 (36.4%)
AXL (mm) 23.22 ± 1.20 21.22 – 25.92
ACD (mm) 2.97 ± 0.50 1.85 – 4.03
K1 (D) 42.82 ± 1.87 40.13 – 47.14
K2 (D) 44.43 ± 2.08 40.42 – 48.73
CYL (D) -1.47 ± 1.27 -4.50 – 1.50
SEQ (D) 1.11 ± 2.74 -6.25 - +5.75
UCDVA (decimal) 0.32 ± 0.18 0.01 – 0.60
BCDVA (decimal) 0.65 ± 0.16 0.15 – 0.90
UCNVA (decimal) 0.31 ± 0.22 0.00 – 0.90
BCNVA (decimal) 0.77 ± 0.24 0.00 – 1.00
IOP (mmHg) 15.6 ± 3.05 11.0 – 25.0
Implanted IOLs
15.0 15.5 16.0 16.5 17.0 17.5 18.0 18.5 19.0 19.5 20.0 20.5 21.0 21.5 22.0 22.5 23.0 23.5 24.0 24.5 25.0 25.5 26.0 26.5 27.0 27.5 28.0
0
1
2
3
4
5
6
IOL SEQ (Dioptres)
Nu
mb
er
of
IOL
s
1 1.50 2.25 3.00 3.75
0
2
4
6
8
10
12
14
16
IOL cylinder (Dioptres)
Nu
mb
er
of
IOL
s
Clinical results
Visual outcome, Predictability,
Efficacy, Stability
LO:GO
Implantation is safe
Preop D1 D7 M1 M2 M3
0
5
10
15
20
25
IOP
(m
mH
g)
• No complcations or adverse events occured
during the surgery or the follow-up period
• Intraocular pressure is stable
• Biomicroscopic and fundoscopic evaulations
show normal conditions
• Day 1 and Day 7: 9 and 5 eyes showed corneal
edema, which vanished until the next visit
• 3 month after surgery, 2 eyes of the same
patients were diagnosed with age-related
macular degeneration (AMD). This patient was
excluded from the analysis.
• 2 patients were found to have dry-eye
syndrome at the 3 months follow-up visit
LO:GO
Distance vision improved, results are close to the best achievable
LO:GO
Distance vision improved, less correction is needed
Preop M3 Preop M3
-10
-8
-6
-4
-2
0
2
4
6
Co
rrec
tio
n (
Dio
ptr
es)
SPH CYL
Mean SD n Mean SD n Mean SD n
Preop 0.68 0.14 12 0.38 2.56 12 -1.79 1.20 12
M3 0.98 0.04 12 0.00 0.35 12 0.32 0.20 12
Δ Correction -0.43 2.68 11 -1.55 1.07 11
BCDVA SEQ CYL
LO:GO
Near vision is improved
Preop M1 M2 M3
0.0
0.2
0.4
0.6
0.8
1.0
1.2
Vis
ua
l A
cu
ity
(d
ec
ima
l) BCNVA
Mean SD n
Preop 0.77 0.24 35
M1 0.98 0.06 25
M2 1.00 0.02 20
M3 0.98 0.07 35
BCNVA
LO:GO
Bi-Flex 677TAY toric IOLs are efficient in correcting both refractive errors
and astigmatism
Preop
Month 3
LO:GO
Results are predictable (calculations are precise)
Predicted Actual (M3)
-2.0
-1.5
-1.0
-0.5
0.0
0.5
1.0
1.5
2.0
Co
rrec
tio
n (
Dio
ptr
es) SEQ
CYL
Mean SD n Mean SD n
Predicted -0.04 0.15 35 0.28 0.24 35
Actual (M3) -0.16 0.33 35 -0.44 0.28 35
SEQ CYL
-0.4 -0.2 0.0 0.2 0.4
-1.0
-0.8
-0.6
-0.4
-0.2
0.0
0.2
0.4
0.6
0.8
1.0
Predicted SEQ
Actu
al S
EQ
Y = 0.5697*X - 0.1352
LO:GO
Refractive stability is confirmed
Preop D1 D7 M1 M2 M3
-4
-3
-2
-1
0
1
2
3
4
Dio
ptr
es
SPH
CYL
SEQ
Mean SD n Mean SD n Mean SD n
Preop 1.11 2.74 34 -1.47 1.27 32 0.42 2.60 34
D1 0.19 0.65 22 -0.85 0.69 22 -0.24 0.46 21
D7 0.36 0.65 20 -0.43 0.26 19 0.14 0.58 23
M1 -0.02 0.31 26 -0.57 0.43 26 -0.30 0.39 26
M2 0.02 0.27 22 -0.39 0.58 22 -0.17 0.43 22
M3 0.06 0.29 35 -0.44 0.28 35 -0.16 0.33 35
SPH CYL SEQ
LO:GO
Astigmatism correction is predictable and efficient
Error in CYL(Pred. vs. Actual)
-3
-2
-1
0
1
2
3
Dip
otr
es
Reduction in CYL(Preop vs. M3)
-6
-4
-2
0
2
4
Dip
otr
es
0.18 ± 0.37 D -1.01 ± 1.28 D
LO:GO
Rotation is minimal → Excellent rotational stability is confirmed
D1 D7 M1 M2 M3
0
2
4
6
8
10
Ro
tati
on
(°)
D1 D7 M1 M2 M3
0
2
4
6
8
10
Ro
tati
on
(°)
There was no rotation of more than 5°
during the first 3 postoperative months
Signed values
Absolute values
Conclusions and Take Home Messages
2
3
4
1
Safe implantationNo complications or avderse events suring or after
the surgery
Efficient correction of refractive
errors and astigmatismRefractive results are close to target.
Predictable outcomeActual refractive results are close to those estimated by the
Medicontur IOL Optimizer prior to surgery.
Refractive and Rotational StabilityDuring the 3-months follow-up no refractive shift or any off-axis rotation
exceeding 5° occurred.
Thank you for your
kind attention!