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 via luminance analysis in ImageJ. The clinical study included 201 eyes with grade 2 nuclear cataracts. Axis marking was done 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 post-operatively. 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 s vs. 233.6 ± 119.2 s; 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 versus 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.
Noguchi et al. (Mon,) studied this question.
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