All patients underwent a complete ophthalmologic measurement. Visual acuity included uncorrected and corrected distance visual acuity (UDVA and CDVA) and uncorrected and corrected near visual acuity (UNVA and CNVA). Biometry, such as axial length, WTW, and CCT, was performed using a Lenstar noncontact optical low-coherence reflectometer (LS900; Haag-Streit, Koniz, Switzerland). Corneal volume (CV) and TCA were obtained using a Pentacam (70700, Oculus, Wetzlar, Germany). Anatomic landmarks of the eye were obtained using the Verion Image-Guided System (Alcon Laboratories, Inc., Fort Worth, TX, America).
Verion image guided system
Manufactured by Alcon
Sourced in United States
The VERION Image Guided System is an ophthalmic imaging device that captures and processes detailed images of the eye. The system combines several imaging technologies to provide comprehensive data about the eye's structure and features. Its core function is to acquire and analyze visual information to assist healthcare professionals in various ophthalmic procedures.
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9 protocols using verion image guided system
1
Comprehensive Ophthalmic Measurements Protocol
2
Toric IOL Exchange with Symfony Lens
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All the surgeries were performed by the same experienced surgeon (RT). The primary cataract surgery used a standard phacoemulsification technique under local anesthesia. A 2.4–3.0 mm clear corneal incision was made at the steepest corneal meridian, depending on the power and axis of the corneal astigmatism. Toric type IOLs were selected with 1.5 D or more for with-the-rule and 1.0 D or more for against-the-rule and oblique astigmatism. The corneal incision’s position and IOL axis were aligned using the VERION image guided system (Alcon, Fort Worth, Texas, USA).
The IOL exchange surgery used the same corneal incision of the previous cataract surgery. The corneal incision was opened, a viscoelastic material was injected, and the IOL was released from the capsular bag. The IOL optics were cut in half with scissors for easy explantation through the small wound and TECNIS Symfony® was implanted in the capsular bag using an injector. No intraoperative complications were observed.
The IOL exchange surgery used the same corneal incision of the previous cataract surgery. The corneal incision was opened, a viscoelastic material was injected, and the IOL was released from the capsular bag. The IOL optics were cut in half with scissors for easy explantation through the small wound and TECNIS Symfony® was implanted in the capsular bag using an injector. No intraoperative complications were observed.
3
Optimized Cataract Surgery Using VERION System
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All phacoemulsification procedures were performed under topical anesthesia (proparacaine 0.5%). The VERION Image-Guided System (Alcon Laboratories Inc., Fort Worth, Texas, USA) was used to determine the steep meridian axis orientation and digital markers for the microscopy (Fig. 3 ). A 2.2-mm, single-step CCI was made in the pre-limbal region of the steep meridian using a dual-beveled, angled, slit knife (Alcon Laboratories Inc.), and a side port incision (full-thickness puncture) was made using a 1.0-mm knife, 60 degrees left of the main incision site. Lastly, the CCI size was enlarged from 2.3 mm to 3.2 mm for correcting corneal astigmatism and intraocular lens (IOL) insertion. The corneal wounds were left unsutured (sutureless). Preoperative and 2-month postoperative keratometric data were compared. Polar value analysis was used to assess SIACornea. Patients were divided into four groups based on the incision site: temporal, superotemporal, superonasal (opposite site of incision: inferiortemporal), and superior4 (link).![]()
The VERION Image-Guided System was used to determine the steep meridian axis orientation and digital markers for the microscopy.
4
Phakic Posterior Chamber IOL Implantation
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A written informed consent was obtained from all patients. All surgeries were performed by a single experienced surgeon (DR). Topical anesthetic (proparacaine hydrochloride ophthalmic solution 0.5%) and mydriatic agents (tropicamide 0.8% and phenylephrine hydrochloride 5%) were instilled prior to the procedure. The phakic posterior chamber intraocular lens was implanted into the anterior chamber through a 3 mm clear corneal incision following ophthalmic viscoelastic device (HEALON OVD, sodium hyaluronate, Johnson & Johnson Vision, Santa Ana, CA, USA) injection. The footplates were subsequently tucked behind the iris, followed by a thorough OVD wash. Digital image guided system (Verion image guided system; Alcon, Fort Worth, TX, USA) allowed measurement of intraoperative cyclotorsion and correct placement of the toric implants. Customization of the toric IPCL allows placement of the implant at the 0°–180° horizontal axis for all cases.
Postoperative treatment regimen included steroids (loteprednol eye drops 0.5%) in tapering doses and antibiotic drops (moxifloxacin ophthalmic solution 0.5%) and antiglaucoma medication (timolol maleate eye drops 0.5%) for 2 weeks.
Postoperative treatment regimen included steroids (loteprednol eye drops 0.5%) in tapering doses and antibiotic drops (moxifloxacin ophthalmic solution 0.5%) and antiglaucoma medication (timolol maleate eye drops 0.5%) for 2 weeks.
5
Toric Phakic Posterior Chamber Lens Implantation
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Written informed consent was obtained from all patients. All surgeries were performed by a single experienced surgeon (DR). Topical anesthetic and mydriatic agents were instilled before the procedure. The phakic posterior chamber intraocular lens was implanted into the anterior chamber through a 3-mm clear corneal incision. The footplates were subsequently tucked behind the iris, followed by a thorough ophthalmic viscoelastic device (HEALON OVD, sodium hyaluronate, Johnson and Johnson Vision, Santa Ana, CA, USA) wash. Digital image-guided system (Verion Image guided system, Alcon, Novartis) allowed measurement of intraoperative cyclotorsion and correct placement of the toric implants. The placement of the ICL entails rotation of up to 22.5° from the horizontal axis. Customization of the IPCL on the other hand allows placement of the implant at the 0–180° horizontal axis in all cases.
Postoperative treatment regimen included steroids (L-Pred, loteprednol 0.5%, Allergan) in tapering doses and antibiotic drops (Vigamox, moxifloxacin ophthalmic solution 0.5%, Alcon, Novartis AG) for 2 weeks.
Postoperative treatment regimen included steroids (L-Pred, loteprednol 0.5%, Allergan) in tapering doses and antibiotic drops (Vigamox, moxifloxacin ophthalmic solution 0.5%, Alcon, Novartis AG) for 2 weeks.
6
3D-Assisted Intraoperative Lens Optimization
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We performed IP-LOT using the NGENUITY 3D® Visualization System with the VERION Image Guided System (Alcon, Fort Worth, TX, USA), which includes a 3-D high dynamic range (HDR) camera with a complementary metal-oxide-semiconductor image sensor, specialized software (TrueWare, version 9.5.4; TrueVision Systems, Inc., Santa Barbara, CA, USA), and a high-definition 55" LCD monitor with a 4K OLED display (LG, Seoul, Republic of Korea) that uses passive 3-D display technology (Fig 1 ).
For the best 3D effect, the display was positioned next to the operative eye and 4–6 feet (1.2. 1.8 m) away from the surgeon. The screen was at the same height as the surgeon when the surgeon was seated at the operating table. We adjusted the height, tilt, and distance of the display at the discretion of the doctor to provide the best image.
For the best 3D effect, the display was positioned next to the operative eye and 4–6 feet (1.2. 1.8 m) away from the surgeon. The screen was at the same height as the surgeon when the surgeon was seated at the operating table. We adjusted the height, tilt, and distance of the display at the discretion of the doctor to provide the best image.
7
Cataract Surgery with Verion System
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All surgeries were performed by the same experienced surgeon under topical anaesthesia. The Centurion Vision System (Alcon, Fort Worth, TX, USA) was used to obtain a clear corneal phacoemulsification through a 2.2 mm main incision and a 1 mm lateral incision in all subjects. The Verion Image Guided System (Alcon, Fort Worth, TX, USA) was used to demonstrate a capsulorhexis diameter of 5.0 mm and the centre of the IOLs.
8
Evaluating Cyclotorsion in Cataract Surgery
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We retrospectively reviewed a consecutive series of eyes with a cataract, which was treated with phacoemulsification and aspiration (PEA) with IOL implantation between January and May 2016, and in which cyclotorsion was evaluated using the VERION Image Guided System (Alcon Laboratories). Two surgeons (T.O. and H.T.) performed all surgeries at the Department of Ophthalmology at the Jikei University School of Medicine (Tokyo, Japan). In accordance with the routine procedure in our hospital, all patients scheduled to undergo surgery were provided a thorough explanation of the risks and benefits of surgery, including a discussion of nonsurgical alternatives. Informed patient consent was then obtained. This study was approved by the institutional review board of the Jikei University School of Medicine (approval number: 30–142(9163)). Informed consent for the use of medical record was obtained from all patients, and patient data were used in accordance with the tenets of the Declaration of Helsinki.
9
Microincision Phacoemulsification with Intraoperative Guidance
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All surgeries were performed by the same experienced surgeon (AM) using topical anaesthesia. A standard technique of sutureless microincision phacoemulsification was performed for the implantation of the RayOne T, PanOptix, and Acrysof monofocal IOLs; 2.4 mm corneal incision was placed in temporal side, the capsulorhexis diameter was 5.2 mm and the IOL was implanted in the capsular bag. The IOL centering and capsulorhexis size were performed with the assistance of an intraoperative digital system (Verion Image Guided System, Alcon Laboratories, Inc., Fort Worth, TX). No intraoperative complications occurred at any level during all surgeries.
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