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Evaluation of a toric intraocular lens with a Z-haptic

Evaluation of a toric intraocular lens

with a Z-haptic

Don Julian De Silva,MRCOphth,MRCS Ed,Yashin D.Ramkissoon,PhD,MRCP,MRCOphth,

Philip A.Bloom,FRCOphth,FRCS Ed

PURPOSE:To evaluate the efficacy and rotational stability of the MicroSil6116TU foldable3-piece sil-icone toric intraocular lens(IOL)(HumanOptics).

SETTING:Department of Ophthalmology,Hillingdon Hospital,Uxbridge,Middlesex,United Kingdom. METHODS:This prospective observational study included21eyes of14consecutive patients with more than1.50diopters(D)of preexisting corneal astigmatism having cataract surgery.Phacoemulsi-fication was performed,and a MicroSil6116TU toric IOL was inserted through a3.4mm temporal cor-neal incision.LogMAR uncorrected visual acuity(UCVA),best corrected visual acuity,refraction, keratometry,and cylinder axis of the toric IOL were measured.

RESULTS:The mean preoperative refractive and keratometric astigmatism was3.52D G1.11(SD)and 3.08G0.76D,respectively.Six months postoperatively,the logMAR UCVA in eyes without ocular co-morbidity(n Z14)was0.20G0.15(Snellen20/32).Seventy-nine percent(11eyes)had a visual acuity of0.24(Snellen20/35)or better.The mean refractive astigmatism at6months was1.23G0.90D.Vec-tor analysis using the Holladay-Cravy-Koch method showed a mean reduction in refractive astigma-tism of2.16G2.33D.The mean difference between intended and achieved cylinder axis at 6months was5.2degrees(range0to15degrees).No IOL rotated more than5degrees during the follow-up period.

CONCLUSIONS:The MicroSil6116TU toric IOL reduced visually significant keratometric astigmatism and increased spectacle independence.The IOL was stable in the capsular bag,showing no significant rotation up to6months postoperatively.

J Cataract Refract Surg2006;32:1492–1498Q2006ASCRS and ESCRS

More than15%of patients have visually significant refrac-tive astigmatism.1–4With increased expectations from cat-aract surgery,including the desire for postoperative spectacle independence,greater emphasis is being placed on simultaneous surgical correction of keratometric astigmatism.

Corneal astigmatism can be reduced with a variety of surgical techniques including selective positioning of the phacoemulsification incision,corneal relaxing incisions, limbal relaxing incisions(LRIs),implantation of toric in-traocular lenses(IOLs),and photorefractive keratectomy. However,all methods have limitations.Limbal relaxing incisions are placed as single or opposite paired peripheral arcuate incisions centered on the steep corneal meridian. The refractive changes induced by these incisions are sub-ject to a number of variables such as age,sex,magnitude and axis of astigmatism,and incision number,depth,and length.4–10Limbal relaxing incision nomograms treat up to4.0diopters(D)of astigmatism;however,outcomes are less predictable with higher levels of astigmatism caused by variable tissue healing.5–12In addition,LRIs may have long-term mechanical instability,be associated with postoperative ocular surface discomfort,and increase the potential for globe rupture after trauma.1,9,10 The use of toric IOLs to reduce visually significant ker-atometric astigmatism offers a rational,more predictable,

Accepted for publication April14,2006.

From the Hillingdon Hospital,Department of Ophthalmology, Uxbridge,Middlesex,and Western Eye Hospital,Department of Ophthalmology,London,United Kingdom.

Presented at the annual meeting of the American Academy of Ophthalmology,Chicago,Illinois,USA,October2005,and the Royal College of Ophthalmologists Congress,Birmingham, United Kingdom,May2005.

No author has a proprietary or financial interest in any material or method mentioned.

Corresponding author:Mr.Philip Bloom,The Western Eye Hospital,Marylebone Road,London NW16YE,United Kingdom. E-mail:philipbloom@https://www.wendangku.net/doc/d66093820.html,.

Q2006ASCRS and ESCRS Published by Elsevier Inc.0886-3350/06/$-see front matter doi:10.1016/j.jcrs.2006.04.022

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and stable method of refractive correction.Precise align-ment of the cylinder axis of a toric IOL along the steep corneal meridian is critical for maximum astigmatic correc-tion.5,11–13Postoperative rotation of previous-generation toric IOLs(with plate or C-loop haptics)is a significant limitation of this technology.2,5,11–13There is extensive clinical experience with single-piece,silicone,plate-haptic toric IOL models AA4203TF and AA4203TL(Staar Surgical Co.).The IOL is available in2cylindrical powers(2.00D and3.50D),although the effective cylindrical power is less at the corneal plane(1.40D and2.30D).The plate hap-tics have fenestrations and a frosted surface to enhance postoperative fixation in the capsular bag;however,more than10%rotate significantly,more than10degrees,in the postoperative period(Table1).1,13–17Options for treat-ing patients with greater than3.50D of keratometric astig-matism include combining the Staar toric IOL with LRIs, piggyback implantation of2Staar toric IOLs,or custom-manufactured poly(methyl methacrylate)(PMMA)toric IOLs.9,13,18

A3-piece silicone toric IOL,the MicroSil6116TU(Hu-manOptics),has been introduced to the European market, with U.S.Food and Drug Administration approval currently being sought.The IOL is available in cylindrical powers of 2.00to12.00D(in1.00D increments)and has patented Z-design haptics that are advertised to provide greater rota-tional stability of the IOL in the capsular bag(Figure1).We evaluated the astigmatic correction and rotational stability of this IOL in a series of cataract surgery patients with naturally occurring keratometric astigmatism greater than 1.50D.

PATIENTS AND METHODS

This prospective observational study included21eyes of14 consecutive patients with visually significant age-related cataract and preexisting regular keratometric astigmatism greater than https://www.wendangku.net/doc/d66093820.html,rmed consent was obtained from all patients.Patients with medically controlled open-angle glaucoma and mild age-related macular changes were included.Those with advanced glaucoma or retinal disease were excluded.

Preoperatively,logMAR best corrected visual acuity(BCVA) and biometry were determined.Refraction,keratometry,and topography were obtained using the KR7000P autokeratorefrac-

tometer(Topcon).Axial length was measured by immersion

A-scan ultrasonography(Ophthasonic Image2000A-Scan, Teknar).Calculation of the required spherical and cylindrical

powers of the MicroSil toric IOL to achieve emmetropia and

maximum astigmatic correction was performed using an internal

company program based on ray-tracing developed by the Univer-sity of Erlangen and HumanOptics.Each MicroSil6116TU toric IOL was custom manufactured by HumanOptics.The IOL has an A-constant of118.6and a spherical anterior surface,posterior toric surface,and high-molecular-weight PMMA Z-design haptics (Figure1).

All21eyes had sutureless phacoemulsification with inser-

tion of a MicroSil6116TU foldable3-piece silicone toric IOL be-tween February2004and February2005.After topical anesthesia consisting of proxymetacaine0.4%eyedrops was ad-ministered,the corneal limbus was marked at the90-degree and 270-degree positions with a25-gauge sterile needle at the slit-lamp after careful vertical alignment of the patient’s head.All patients were given a peribulbar anesthetic block and prepared and draped for surgery.At the start of surgery,the steep corneal meridian was identified and marked using a Mendez gauge with the aid of the preplaced reference points.All cataract surgery was performed by a single surgeon(P.B.)in a standardized man-ner.After a continuous curvilinear capsulorhexis was created, hydrodissection divide-and-conquer phacoemulsification was performed through a2.8mm temporal corneal incision.The cor-neal wound was enlarged to3.4mm and the MicroSil6116TU toric IOL inserted in the capsule.Care was taken to avoid Z-hap-tic damage during implantation.The IOL was rotated to align the cylinder axis with the marked steep corneal meridian.Cor-rect alignment of the toric IOL was verified at the end of surgery. Standard postoperative topical steroid and antibiotic eyedrops were prescribed.All patients were examined1and14days and6months postoperatively.At each follow-up visit,logMAR visual acuity,refraction,keratometry,and IOL axis were deter-mined.The cylinder axis of the IOL was measured at the slit-lamp using the beam protractor after pupil dilation,ensuring vertical alignment of the patient’s head position.

The Student t test was used to compare preoperative and postoperative refractive and keratometric astigmatism.A P value less than0.05was considered statistically significant.Vector anal-ysis of the surgically induced refractive change(SIRC)and surgi-cally induced corneal refractive change(SICRC)was performed using the Holladay-Cravy-Koch(HCK)method and preoperative and postoperative refractive and keratometric astigmatism mea-surements.19,20The IOL-induced refractive change was defined as SICRC minus SIRC.21All data were analyzed with Microsoft Office Excel2003on a personal computer.

Table1.Mean preoperative and postoperative visual acuity.

Preoperative Postoperative(6Months)

Group Mean UCVA Mean BCVA Mean UCVA Mean BCVA DVLA* Eyes with no ocular comorbidity(n Z14)0.44G0.210.32G0.200.20G0.150.12G0.1111(78.6) Eyes with ocular comorbidity(n Z7)0.77G0.460.68G0.490.64G0.080.53G0.140

All eyes(n Z21)0.55G0.340.44G0.360.32G0.240.23G0.2211(57.1) Means G SD

BCVA Z best corrected visual acuity;UCVA Z uncorrected visual acuity

*Patients achieving UCVA sufficient to meet UK Driving&Vehicle Licensing Authority(DVLA)Type1license requirement

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RESULTS T wenty-one eyes of 14consecutive patients were eval-uated in this study.The mean age was 76.1years G 11.4(SD)(range 55to 92years).Surgery was performed on 13right eyes (61.9%)and 8left eyes (38.1%).

Visual Outcomes

The results were divided by 2groups:patients with preexisting ocular comorbidity and patients without preex-isting ocular comorbidity.Table 1shows the mean preoper-ative and postoperative uncorrected visual acuity (UCVA)and BCVA in both groups.Six months postoperatively ,the mean logMAR UCVA was 0.20G 0.15(Snellen equiv-alent 20/32)in eyes with no ocular comorbidity (Figure 2).Patients with mild ocular comorbidity ,including medically controlled primary open-angle glaucoma,corneal endothe-lial guttata,and mild age-related maculopathy were not ex-cluded from the study .However,subanalysis of this group of patients showed only a modest improvement in mean UCVA to 0.64G 0.08(20/87)and a mean BCVA of 0.53G 0.14(20/68).

Spherical Target

The mean preoperative refractive sphere was 2.58G 3.14D and the mean preoperative spherical equivalent,0.82G 3.28D.Six months postoperatively ,the mean refrac-tive sphere was à0.13G 1.00D and the mean spherical equivalent,à1.07G 0.82D.Eighteen patients (56%)had a mean postoperative spherical equivalent within G 1.50D of emmetropia.The calculation of the spherical and cylindri-cal powers of the IOL was performed by HumanOptics using the internal company program and an A-constant of 118.6.

Refractive Astigmatism

The mean refractive astigmatism was 3.52G 1.11D (range 1.00to 5.25D)preoperatively and 1.23G 0.90D (range 0.25to 3.50D)6months postoperatively.The total reduction in mean refractive astigmatism,2.29G 1.70D,was statistically significant (P !.05,t test).Figure 3shows the mean preoperative and postoperative refractive and ker-atometric astigmatism and Figure 4,a scatterplot of pre-operative versus postoperative refractive astigmatism.T wo patients had an increase in refractive astigmatism postoper-atively.One had a preoperative refractive astigmatism of 1.00D that increased to 2.50D postoperatively;however,

102030405060708090100C u m u l a t i v e p e r c e n t a g e o f p a t i e n t s

Post-operative Uncorrected LogMAR visual acuity

Figure 2.Uncorrected visual acuity in patients without ocular comorbidity 6months

after surgery.The vertical line indicates the legal visual acuity requirement for driving a passenger car in the

U.K.

0.511.522.533.54D

i o p t e r s

Figure 3.The change in mean keratometric and refractive astigmatism after toric IOL implantation.

Figure 1.The HumanOptics MicroSil 6116TU foldable 3-piece silicone toric IOL consists of a spherical anterior surface,posterior toric surface,PMMA Z-design hap-tics,and an A-constant of 118.6.All measurements are in millimeters.

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the patient’s UCVA was 0.10(20/25).The second patient,aged 89years,had a 1.50D increase in refractive astigma-tism with the IOL off the intended axis by 6degrees and a UCVA of 0.50(20/63).The postoperative astigmatic change was attributed to deterioration in the patient’s Fuchs’endothelial dystrophy .Neither case was attributable to an error in the meridian of the surgical incisions.

Keratometric Astigmatism

Mean keratometric astigmatism was 3.08G 0.76D (range 1.75to 4.75D)preoperatively and 2.90G 1.52D (range 0.88to 7.75D)6months postoperatively .The total reduction in mean keratometric astigmatism was 0.18G 1.59D,which was not statistically significant (P O .05,t test).

Toric Intraocular Lenses

The mean spherical power of the toric IOLs used was 17.93G 6.02D (range 8.00to 25.00D).The mean cylin-drical power of the toric IOLs was 4.19G 1.29D (range 2.00to 6.00D).

Astigmatism Reduction

Six months postoperatively ,the astigmatism reducing-effect that was attributable to the toric IOL,calculated by vector analysis with the HCK formula,was 2.16G 2.33D.

Rotational Stability

The mean difference between the intended axis and achieved cylinder axis was 5degrees (range 0to 15de-grees)6months postoperatively .All patients were within G 15degrees of the intended axis,and 90%were within

G 10degrees (Figure 5).One patient’s IOL was 11degrees off axis on the first postoperative day.At 1week,the IOL was at the same axis,with a residual refractive astigmatism of 2.00D.Secondary repositioning of the IOL was per-formed,with the final position within G 5degrees of the in-tended axis.The UCVA at 6months was 0.2(20/32),with a residual postoperative refractive cylinder of à0.50D.No toric IOL rotated more than 5degrees during the 6-month postoperative follow-up.

Complications

In this series,21MicroSil toric 6116TU IOLs were im-planted with 1intraoperative complication:2clock hours of zonular dehiscence occurred during IOL insertion in a 76-year-old patient with no clinical evidence of pseudoex-foliation or history of trauma.There was no vitreous loss,and central IOL positioning was achieved with accurate axis alignment.At 6months,UCVA was 0.4(20/50)and BCVA was 0.16(20/29)with à1.25à0.75?126.Post-operative complications were limited to 1patient requiring secondary alignment of the toric IOL.

DISCUSSION

The use of toric IOLs to correct keratometric astigma-tism is frequently complicated by rotation of the IOL in the capsular bag.1,2,13–17,22–26The recently introduced Micro-Sil 6116TU foldable 3-piece silicone toric IOL has Z-design PMMA haptics advertised to provide greater stability.This is the first study to report the efficacy and rotational stabil-ity of this toric IOL in a series of cataract patients with keratometric astigmatism greater than 1.50D.The IOL corrected refractive astigmatism across a large dioptric

Pre-operative cylinder (D)

P o s t -o p e r a t i v e c y l i n d e r (D )

Figure 4.Scatterplot of mean preoperative versus mean postoperative re-fractive astigmatism.Values below the diagonal line indicate a reduction in refractive cylinder after surgery.

102030405060708090100C u m u l a t i v e p e

r c e n t a g e o f p a t i e n t s

Degrees of toric IOL from intended axis

Figure 5.Graph of the deviation of toric IOL position from the intended axis (degrees).

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range and demonstrated stability with no significant IOL rotation over a6-month follow-up.It is available to treat high levels of refractive astigmatism(2.00to12.00D) compared to that with other plate-haptic design toric IOLs,which are limited to cylindrical powers up to3.50D, with an effective power of up to2.30D at the corneal plane.

Six months postoperatively,eyes without ocular comorbidity(n Z14)achieved a mean logMAR UCVA of0.20G0.15(20/32),consistent with published data.1,14,16,17In this group,11eyes(78.6%)attained an acuity of0.24(20/35)or better,corresponding to the legal visual acuity requirement to drive a passenger vehicle in the United Kingdom(Figure2).The diminution in visual acuity resulting from uncorrected regular astigmatism is dependent on the amount and axis of astigmatism.27If a conventional spherical IOL were used to achieve emme-tropia for sphere,assuming no change in astigmatic error after surgery,the limitation of postoperative UCVA from re-sidual astigmatism alone may be estimated.27This hypo-thetical calculation for our dataset would yield a mean postoperative logMAR UCVA of0.82(20/132),assuming no ocular comorbidity.Thus,without toric IOL implanta-tion,UCVA in only1of21eyes would meet the legal driv-ing standard for visual acuity in the U.K.Patients with mild coexisting ocular morbidity showed only a modest im-provement in vision postoperatively,with mean a UCVA of0.64G0.08(20/87)and a mean BCVA of0.53G0.14 (20/68).Therefore,patients with mild ocular comorbidity do less well with toric IOL implantation.

The astigmatism correction using toric IOLs is imperfect.2,16,23,26In a series reported by Chang,22the 11.2mm length TL toric IOL achieved a mean reduction in refractive astigmatism of2.76G1.20D.Our data on the MicroSil6116TU toric IOL showed a mean reduction in refractive astigmatism of2.29G1.70D.Hypothetical reasons for incomplete correction of refractive astigmatism include biometric error,keratometric change resulting from the corneal incision,and tilting of the toric IOL in the capsular bag.2,16,23,26The MicroSil6116TU toric IOL requires a wound of at least3.5mm for insertion,but this is unlikely to significantly effect postoperative astigmatism compared to smaller temporal incisions.27–29Capsule fibrosis and epithelial proliferation may have an impact on toric IOL rotation and tilting in the capsular bag.

Toric IOLs with C-loop or plate-haptic designs are prone to rotate from their intended axis postoperatively. Table2shows a summary of published data on toric IOL rotation.Rotation by10degrees reduces the cylindrical power of the toric IOL by approximately one third and by two thirds if the IOL rotates off axis by20degrees.14,22 Traditional C-loop haptic IOLs have the highest rate of postoperative rotation,with up to41%rotating more than10degrees.23Early design plate-haptic IOLs rotated less frequently,with9%to38%rotating more than 10degrees.2,14,24,25Current-generation plate-haptic toric IOLs have increased rotational stability,but the incidence of IOL rotation remains significant.The shorter(10.8mm) plate-haptic toric TF rotates significantly in the postoperative

Table2.Published data of toric IOL rotational stability.

Study*Year

IOL

Type

IOL

Rotation Time/Weeks Number

2nd Surgical

Procedure(%)

Sanders141992Early plate haptic10.4mm9%R15 152d Shimizu231994C-loop haptic,3piece21%R30 1247d Grabow24,251994Staar4203T10.8mm 4.4%O33 d d d Werblin261999J-loop haptic,3piece8%O30 Early12d

Patel2,?1999Loop haptic,3piece

Plate haptic10.4mm 41%O10

38%O10

223

Staar Staar TF10.8mm25%O20 Early d Sun152000Staar TF10.8mm25%O20 121309.2 Ruhswurm212000Staar TF10.8mm19%R10 80373 Gerten132001Custom3-piece PMMA26%O10 32623(6eyes) Leyland162001Staar TF10.8mm18%O30 822

Till12002Staar mixed TF/TL14%O15 231009

Chang222003Staar TF10.8mm

Staar TL11.2mm 50%R15

10%R10

Current2005HumanOptics MicroSil6116TU

3-piece silicone optic,

PMMA Z-haptics

0%O10 26214(1eye)

IOL Z intraocular lens;PMMA Z poly(methyl methacrylate)

*First author only

?IOL rotation in nontoric loop and plate-haptic IOL

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period,with18%to50%rotating by more than10 degrees.1,30–32The longer(11.2mm length)TL toric IOL is more stable in the capsular bag,with only2%(in1of 50eyes)rotating10%or more.14,22

We found the MicroSil toric IOL to be stable once po-sitioned in the capsular bag,with no IOL rotating more than5degrees during the6-month postoperative period. We interpret changes of fewer than5degrees in IOL axis to be within the margin of error(when measuring axis po-sition using a slitlamp)rather than a result of true move-ment of the IOL in the capsular bag.

The Z-design haptics effectively secure the IOL in the capsular bag.Once implanted,the IOL’s haptics exert enough expansile force to stabilize the IOL.This is aided by the corrugated nature of the haptic surface touching the capsular equator.Dialing the IOL to achieve correct alignment of the cylindrical correction is not usually possi-ble because of the risk for zonular dehiscence or capsule trauma.We rotate the IOL by simultaneously compressing both Z-haptics at the elbows using2instruments to ‘‘release’’the IOL before it is turned.Small adjustments in the IOL axis can be made in this way.Caution should be exercised in patients with zonular instability or floppy capsules.The use of capsular tension rings in combination with this toric IOL has not been described,but such a device may increase the difficulty of rotating this IOL if the haptics are trapped by the tension ring.Significant zonular weakness may,therefore,be considered a relative contraindication.

In addition to increased rotational stability,the Micro-Sil toric IOL corrects up to12.00D of cylinder.Previously, patients with greater than3.50D of keratometric astigma-tism were managed by combining implantation of a Staar toric IOL with LRIs.Alternatively,piggyback implantation of2Staar toric IOLs and use of custom PMMA toric IOLs have been reported.9,13,18Other disadvantages of silicone plate-haptic IOLs,including late IOL decentration caused by capsule fibrosis and posterior dislocation into the vitre-ous cavity after neodymium:YAG laser posterior capsuloto-my,may be avoided by the3-piece design of the MicroSil 6116TU toric IOL.30,31,33,34

The ability to achieve spectacle-independent distance vision using the MicroSil6116TU toric IOL is limited by a number of factors:the astigmatic correction of only1D steps;biometric error;and postoperative refractive changes resulting from wound healing or capsular fibrosis.Further advances in toric IOL technology are likely to involve the development of multicomponent IOLs that could provide a much greater range of cylindrical correction with a smaller inventory than currently available single-element IOLs.35

In conclusion,the MicroSil6116TU toric IOL effec-tively corrected visually significant keratometric astigmatism at the time of cataract surgery and increased spectacle inde-pendence.The IOL was stable in the capsular bag and treated up to5.00D of keratometric astigmatism. REFERENCES

1.Till JS,Yoder PR Jr,Wilcox TK,Spielman JL.Toric intraocular lens im-

plantation:100consecutive cases.J Cataract Refract Surg2002;

28:295–301

2.Patel CK,Ormonde S,Rosen PH,Bron AJ.Postoperative intraocular

lens rotation;a randomized comparison of plate and loop haptic im-plants.Ophthalmology1999;106:2190–2195;discussion by DJ Apple, 2196

3.Hoffer KJ.Biometry of7,500cataractous eyes.Am J Ophthalmol1980;

90:360–368;correction,890

4.Grabow HB.Intraocular correction of refractive errors.In:Kershner RM,

ed,Refractive Keratotomy for Cataract Surgery and the Correction of Astigmatism.Thorofare,NJ,Slack,1994;79–115

5.Tehrani M,Dick HB.Incisional keratotomy to toric intraocular lenses:

an overview of the correction of astigmatism in cataract and refractive surgery.Int Ophthalmol Clin2003;43(3):43–52

6.Budak K,Y?lmaz G,Aslan BS,Duman S.Limbal relaxing incisions in

congenital astigmatism:6month follow-up.J Cataract Refract Surg 2001;27:715–719

7.Lever J,Dahan E.Opposite clear corneal incisions to correct pre-

existing astigmatism in cataract surgery.J Cataract Refract Surg 2000;26:803–805

8.Inoue T,Maeda N,Sasaki K,et al.Factors that influence the surgical

effects of astigmatic keratotomy after cataract surgery.Ophthalmol-ogy2001;108:1269–1274

9.Gills JP.Cataract surgery with a single relaxing incision at the steep

meridian[letter].J Cataract Refract Surg1994;20:368–369

10.Mu¨ller-Jensen K,Fischer P,Siepe U.Limbal relaxing incisions to correct

astigmatism in clear corneal cataract surgery.J Refract Surg1999;

15:586–589

11.Tehrani M,Stoffelns B,Dick HB.Implantation of a custom intraocular

lens with a30-diopter torus for the correction of high astigmatism after penetrating keratoplasty.J Cataract Refract Surg2003;29: 2444–2447

12.Tehrani M,Dick HB,Schwenn O,et al.Postoperative astigmatism and

rotational stability after Artisan toric phakic intraocular lens implanta-tion.J Cataract Refract Surg2003;29:1761–1766

13.Gerten G,Michels A,Olmes A.Torische Intraokularlinsen;klinische

Ergebnisse und Rotationsstabilita¨t.Ophthalmologe2001;98:715–720 14.Sanders DR,Grabow HB,Shepherd J.The toric IOL.In:Gills JP,Martin

RG,Sanders DR,eds,Sutureless Cataract Surgery;an Evolution Toward Minimally Invasive Technique.Thorofare,NJ,Slack,1992;183–197 15.Sun X-Y,Vicary D,Montgomery P,Griffiths M.Toric intraocular lenses

for correcting astigmatism in130eyes.Ophthalmology2000;

107:1776–1781;discussion by RM Kershner,1781–1782

16.Leyland M,Zinicola E,Bloom P,Lee N.Prospective evaluation of a plate

haptic toric intraocular lens.Eye2001;15:202–205

https://www.wendangku.net/doc/d66093820.html,ngenbucher A,Reese S,Sauer T,Seitz B.Matrix-based calculation

scheme for toric intraocular lenses.Ophthalmic Physiol Opt2004;

24:511–519

18.Frohn A,Dick HB,Thiel H-J.Implantation of a toric poly(methyl metha-

crylate)intraocular lens to correct high astigmatism.J Cataract Refract Surg1999;25:1675–1678

19.Holladay JT,Cravy TV,Koch DD.Calculating the surgically induced re-

fractive change following ocular surgery.J Cataract Refract Surg1992;

18:429–443

J CATARACT REFRACT SURG-VOL32,SEPTEMBER20061497

20.Holladay JT,Dudeja DR,Koch DD.Evaluating and reporting astigma-

tism for individual and aggregate data.J Cataract Refract Surg1998;

24:57–65

21.Ruhswurm I,Scholz U,Zehetmayer M,et al.Astigmatism correction

with a foldable toric intraocular lens in cataract patients.J Cataract Refract Surg2000;26:1022–1027

22.Chang DF.Early rotational stability of the longer Staar toric intraocular

lens;fifty consecutive cases.J Cataract Refract Surg2003;29:935–940 23.Shimizu K,Misawa A,Suzuki Y.Toric intraocular lenses:correcting

astigmatism while controlling axis shift.J Cataract Refract Surg 1994;20:523–526

24.Grabow HB.Early results with foldable toric IOL implantation.Eur J Im-

plant Refract Surg1994;6:177–178

25.Grabow HB.Toric intraocular lens report.Ann Ophthalmol1997;

29:161–163

26.Werblin TP.Do three-piece PMMA IOLs rotate after implantation in the

capsular bag?J Refract Surg1995;11:468–471

27.Rao SN,Konowal A,Murchison AE,Epstein RJ.Enlargement of the

temporal clear corneal cataract incision to treat pre-existing astigma-tism.J Refract Surg2002;18:463–46728.Barequet IS,Yu E,Vitale S,et al.Astigmatism outcomes of horizontal

temporal versus nasal clear corneal incision cataract surgery.J Cata-ract Refract Surg2004;30:418–423

29.Werblin TP.Control of astigmatism in cataract surgery[letter].J Re-

fract Surg2003;19:610

30.Negi A,Sinha A.Posterior capsule tear with plate-haptic silicone intra-

ocular lens dislocation.J Cataract Refract Surg2000;26:1558–1559 31.Schneiderman TE,Johnson MW,Smiddy WE,et al.Surgical manage-

ment of posteriorly dislocated silicone plate haptic intraocular lenses.

Am J Ophthalmol1997;123:629–635

32.Dick HB,Alio′J,Bianchetti M,et al.Toric phakic intraocular lens;Euro-

pean multicenter study.Ophthalmology2003;110:150–162

33.Petersen AM,Bluth LL,Campion M.Delayed posterior dislocation of

silicone plate-haptic lenses after neodymium:YAG capsulotomy.J Cat-aract Refract Surg2000;26:1827–1829

34.Faucher A,Rootman DS.Dislocation of a plate-haptic silicone intraoc-

ular lens into the anterior chamber.J Cataract Refract Surg2001;

27:169–171

35.Werblin TP.Why should refractive surgeons be looking beyond the

cornea?The Barraquer Lecture1998.J Refract Surg1999;15:357–376

J CATARACT REFRACT SURG-VOL32,SEPTEMBER2006 1498

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Unit1 Americans believe no one stands still. If you are not moving ahead, you are falling behind. This attitude results in a nation of people committed to researching, experimenting and exploring. Time is one of the two elements that Americans save carefully, the other being labor. "We are slaves to nothing but the clock,” it has been said. Time is treated as if it were something almost real. We budget it, save it, waste it, steal it, kill it, cut it, account for it; we also charge for it. It is a precious resource. Many people have a rather acute sense of the shortness of each lifetime. Once the sands have run out of a person’s hourglass, they cannot be replaced. We want every minute to count. A foreigner’s first impression of the U.S. is li kely to be that everyone is in a rush -- often under pressure. City people always appear to be hurrying to get where they are going, restlessly seeking attention in a store, or elbowing others as they try to complete their shopping. Racing through daytime meals is part of the pace

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安然无恙：很平安，没有受到损失和伤害 - 造句：那次智利大地震，许多城市都毁灭了，但我叔父全家安然无恙，非常幸运。 - 拔苗助长：比喻违反事物的发展规律，急于求成，反而坏事 - 造句：“抢先教育”违背了儿童成长的客观规律，这种拔苗助长的办法结果必将造成对孩子身体和心灵的双重伤害。 - 跋山涉水：形容旅途的艰辛劳苦 - 造句：地质勘探队员不怕艰苦，跋山涉水，为祖国寻找地下的报藏。 - 百看不厌：对喜欢的人，事物等看多少遍都不厌倦。比喻非常喜欢。 -造句：到了节日里，各个景区摆设的花朵真是让人百看不厌。 - 班门弄斧：比喻在行家面前卖弄本领，不自量力 -造句：你在著名华文作家的面前卖弄华文,岂不是班门弄斧。

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- 不可思议：原有神秘奥妙的意思。现多指无法想象，难以理解 - 造句：我看这那座小山觉得不可思议。 -不期而遇：没有约定而遇见 -造句：高兴与悲伤总是不期而遇，或许这就是上帝再捉弄世俗吧！ -不屈不挠：形容顽强斗争,在敌人或困难面前不屈服,不低头那种不屈不挠的、要征服一切的心情 -造句：战士们不屈不挠的坚守在抗震第一线。 - 不速之客：指没有邀请而自己来的客人 - 造句：也不必说有时趁你不防钻进防盗铁门登堂入室的不速之客。 - 不屑置辩：认为不值得辩论 - 造句：孔乙己对那些嘲笑他的人显出不屑置辩的神情。 -不言而喻：形容道理很明显 -造句：你想他们这朋友之乐，尽可不言而喻了。

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常用成语造句大全及解释

常用成语造句大全及解释导读：常用成语及造句大全：【马到功成】形容事情顺利，一开始就取得胜利。朋友要去参加考试我发自内心的祝她马到功成。【安常守故】习惯于日常的平稳糊口，保保守的一套。指保守不知厘革。他持久以来安常守故，缺乏锻炼，故而经不起挫折。【挨门逐户】挨家挨户，一家也没有遗漏。倾销员挨门逐户地倾销产物，可是并没有多少人愿意买【破釜沉舟】比喻下决心悍然不顾地干到底。只要咱们有破釜沉舟的决心，就能克服进修上的各类困难。【大千世界】三昧，世界的千倍叫小千世界，小千世界的千倍叫中千世界，中千世界的千倍叫大千世界。后指广大无边的人世。大千世界无奇不有，充满了抵牾。【空手发迹】一切靠自己艰辛奋斗，创立了一番事业。王董事长空手发迹，如今是王氏集团的总裁。【卷土重来】卷土：人马奔跑时卷起的尘土。形容失败后组织力量，重图恢复。这次角逐虽则表现不佳，但我决定明天卷土重来。【晨钟暮鼓】古代梵宇中晨敲钟，暮伐鼓以报时，用以使人惊悟的言论。每当我想坏事时，就会想起母亲对我的晨钟暮鼓的叮咛。

【力争上游】起劲争取长进求学做人都要力争上游，不要自满於近况【投笔从戎】一小我私家抛弃文职而插手卫国的行列。大伯父高中结业后投笔从戎，步入军校就读，负起保家卫国的责任。【前车之鉴】比喻前人的失败，可以作为后人的借鉴。有了这个前车之鉴，我下次出门一定会带雨具。【金石为开】至诚可感动任何事物。表哥相信精诚所至，金石为开，他的成意一定可以感动王小姐的。【勤能补拙】指勤勉起劲能弥补天资上的不足。勤能补拙，只要你多付出心思，一定有乐成的机会。【揠苗助长】揠：拔起。把苗拔起，以助其生长。后用来比喻违反事物的发展规律，操之过急，反倒坏事。对学生的教育既不能揠苗助长，也能任其自然。【闻鸡起舞】听见鸡鸣就起身，比喻人发奋勇前进修，励精图治。老爷爷在乡间修养，天天闻鸡起舞，打太极健身。【哀鸿遍野】哀鸿：哀鸣的鸿雁。比喻饥寒交迫的灾民。比喻在天灾人祸中到处都是流离失所、呻吟呼号的饥民。旧社会，每逢水灾战乱，人民就被迫四处逃亡，～，一片凄凉。【联袂登台】同台演出今晚的演出听说会有两位名角联袂登台献艺。【使人咋舌】令人惊讶

新视野大学英语读写教程第一册课文翻译及课后答案

Unit 1 1学习外语是我一生中最艰苦也是最有意义的经历之一。虽然时常遭遇挫折，但却非常有价值。 2我学外语的经历始于初中的第一堂英语课。老师很慈祥耐心，时常表扬学生。由于这种积极的教学方法，我踊跃回答各种问题，从不怕答错。两年中，我的成绩一直名列前茅。 3到了高中后，我渴望继续学习英语。然而，高中时的经历与以前大不相同。以前，老师对所有的学生都很耐心，而新老师则总是惩罚答错的学生。每当有谁回答错了，她就会用长教鞭指着我们，上下挥舞大喊：“错！错！错！”没有多久，我便不再渴望回答问题了。我不仅失去了回答问题的乐趣，而且根本就不想再用英语说半个字。 4好在这种情况没持续多久。到了大学，我了解到所有学生必须上英语课。与高中老师不。大学英语老师非常耐心和蔼，而且从来不带教鞭！不过情况却远不尽如人意。由于班大，每堂课能轮到我回答的问题寥寥无几。上了几周课后，我还发现许多同学的英语说得比我要好得多。我开始产生一种畏惧感。虽然原因与高中时不同，但我却又一次不敢开口了。看来我的英语水平要永远停步不前了。 5直到几年后我有机会参加远程英语课程，情况才有所改善。这种课程的媒介是一台电脑、一条电话线和一个调制解调器。我很快配齐了必要的设备并跟一个朋友学会了电脑操作技术，于是我每周用5到7天在网上的虚拟课堂里学习英语。 6网上学习并不比普通的课堂学习容易。它需要花许多的时间，需要学习者专心自律，以跟上课程进度。我尽力达到课程的最低要求，并按时完成作业。 7我随时随地都在学习。不管去哪里，我都随身携带一本袖珍字典和笔记本，笔记本上记着我遇到的生词。我学习中出过许多错，有时是令人尴尬的错误。有时我会因挫折而哭泣，有时甚至想放弃。但我从未因别的同学英语说得比我快而感到畏惧，因为在电脑屏幕上作出回答之前，我可以根据自己的需要花时间去琢磨自己的想法。突然有一天我发现自己什么都懂了，更重要的是，我说起英语来灵活自如。尽管我还是常常出错，还有很多东西要学，但我已尝到了刻苦学习的甜头。 8学习外语对我来说是非常艰辛的经历，但它又无比珍贵。它不仅使我懂得了艰苦努力的意义，而且让我了解了不同的文化，让我以一种全新的思维去看待事物。学习一门外语最令人兴奋的收获是我能与更多的人交流。与人交谈是我最喜欢的一项活动，新的语言使我能与陌生人交往，参与他们的谈话，并建立新的难以忘怀的友谊。由于我已能说英语，别人讲英语时我不再茫然不解了。我能够参与其中，并结交朋友。我能与人交流，并能够弥合我所说的语言和所处的文化与他们的语言和文化之间的鸿沟。 III. 1. rewarding 2. communicate 3. access 4. embarrassing 5. positive 6. commitment 7. virtual 8. benefits 9. minimum 10. opportunities IV. 1. up 2. into 3. from 4. with 5. to 6. up 7. of 8. in 9. for 10.with V. 1.G 2.B 3.E 4.I 5.H 6.K 7.M 8.O 9.F 10.C Sentence Structure VI. 1. Universities in the east are better equipped, while those in the west are relatively poor. 2. Allan Clark kept talking the price up, while Wilkinson kept knocking it down. 3. The husband spent all his money drinking, while his wife saved all hers for the family. 4. Some guests spoke pleasantly and behaved politely, while others wee insulting and impolite. 5. Outwardly Sara was friendly towards all those concerned, while inwardly she was angry. VII. 1. Not only did Mr. Smith learn the Chinese language, but he also bridged the gap between his culture and ours. 2. Not only did we learn the technology through the online course, but we also learned to communicate with friends in English. 3. Not only did we lose all our money, but we also came close to losing our lives.

新大学日语简明教程课文翻译

新大学日语简明教程课文翻译第21课一、我的留学生活我从去年12月开始学习日语。已经3个月了。每天大约学30个新单词。每天学15个左右的新汉字，但总记不住。假名已经基本记住了。简单的会话还可以，但较难的还说不了。还不能用日语发表自己的意见。既不能很好地回答老师的提问，也看不懂日语的文章。短小、简单的信写得了，但长的信写不了。来日本不久就迎来了新年。新年时，日本的少女们穿着美丽的和服，看上去就像新娘。非常冷的时候，还是有女孩子穿着裙子和袜子走在大街上。我在日本的第一个新年过得很愉快，因此很开心。现在学习忙，没什么时间玩，但周末常常运动，或骑车去公园玩。有时也邀朋友一起去。虽然我有国际驾照，但没钱，买不起车。没办法，需要的时候就向朋友借车。有几个朋友愿意借车给我。二、一个房间变成三个从前一直认为睡在褥子上的是日本人，美国人都睡床铺，可是听说近来纽约等大都市的年轻人不睡床铺，而是睡在褥子上，是不是突然讨厌起床铺了？日本人自古以来就睡在褥子上，那自有它的原因。人们都说日本人的房子小，从前，很少有人在自己的房间，一家人住在一个小房间里是常有的是，今天仍然有人过着这样的生活。在仅有的一个房间哩，如果要摆下全家人的床铺，就不能在那里吃饭了。这一点，褥子很方便。早晨，不需要褥子的时候，可以收起来。在没有了褥子的房间放上桌子，当作饭厅吃早饭。来客人的话，就在那里喝茶；孩子放学回到家里，那房间就成了书房。而后，傍晚又成为饭厅。然后收起桌子，铺上褥子，又成为了全家人睡觉的地方。如果是床铺的话，除了睡觉的房间，还需要吃饭的房间和书房等，但如果使用褥子，一个房间就可以有各种用途。据说从前，在纽约等大都市的大学学习的学生也租得起很大的房间。但现在房租太贵，租不起了。只能住更便宜、更小的房间。因此，似乎开始使用睡觉时作床，白天折小能成为椅子的、方便的褥子。

成语解释及例句

初二上语文期末复习之成语运用专项训练 1.恍如隔世：恍惚如同相隔了一辈子。喻事物变化发展很快，变化很大。例句：他曾因躲避战乱而隐居深山，和平后下山才发觉人间变化巨大，真是感觉恍如隔世。 2.轻描淡写：原意是绘画时用浅淡颜色轻轻描绘。形容说话或作文章时对重要的地方淡淡带过。也比喻做事不费力。例句：医生未说实话，看他可怜，就用轻描淡写的话安慰他。如此严重的问题，轻描淡写地说了说就算完了？ 3.与狼共舞：跟恶狼一起跳舞，比喻跟所谋求的对象有利害冲突,决不能成功。后多指跟恶人商量,要他牺牲自己的利益,一定办不到。也说比喻与恶人在一起，随时都有危险，须特别谨慎。例句：没有比与狼共舞更危险的事情。江山易改，本性难移。狼就是狼，无论外表装饰得如何漂亮，不管如何能言善辩，狼就是狼，早晚会露出凶残、狡猾的真面目。 4.林林总总：林林:树木聚集成片的样子;总总:全部汇集状。形容人或事物繁多。例句：在林林总总的这类故事中，也有一个是说鲁班学习海龙王宫殿的建筑艺术。 5.不速之客：速:邀请。没有邀请而自己来的客人。指意想不到的客人。例句：我们正在聚餐时来了一位不速之客。多年不见的老朋友，突然出现在我的眼前，真是不速之客。大会主席团作出决定，会议期间不准无故迟到，对那些不遵守大会纪律的不速之客要通报批评。（不是突然来到的人。语意不符） 6.责无旁贷：自己的责任，不能推卸给别人；贷，推卸。例句：杨丽萍在接受媒体采访时说，保护洱海，她责无旁贷，同时她欢迎广大媒体、网友监督。作为课题负责人，他责无旁贷地走向主席台。（用“当仁不让”更合适，语意不符） 7.如火如荼：像火那样红，像荼（茅草的白花）那样白。原比喻军容之盛，现用来形容旺盛、热烈或激烈。例句：过了两年“五四运动”发生了。报纸上的如火如荼的记载唤醒了他的被忘却了的青春。 8.鳞次栉比：形容房屋密集，像鱼鳞和梳子的齿一样，一个挨着一个地排列着。例句：鳞次栉比的摩天大楼在霍尔河畔奇迹般地崛起，让人以为自己仿佛到了纽约。包头是一个倚山濒水的城市，向北是峰峦鳞次栉比的阴山，向南是波涛汹涌、曲折回环的黄河。（多用来形容房屋或船只等排列得很密很整齐。不能用来形容“山”。） 9.珠光宝气：闪耀着珍宝的光色。多形容妇女服饰华贵富丽。例句：温德姆大堂的香氛过于浓烈，像一个珠光宝气、香水味四溢的贵妇人如影随行。 10.退避三舍：比喻对人让步，不与相争。例句：可见二位仁兄的学问，不但本校众人所不能及，即使天下文才，也当退避三舍哩! 这个地头蛇，人见人怕，连警察见了他都要退避三舍。（“退避三舍”比喻对人让步，不与之相争；不是形容害怕、恐怖。） 11.司空见惯：看惯了的事情，并不觉得奇怪。例句：这种种行为，在我们初来的东方人看来，多少存着好奇心和注意的态度，但在他们已司空见惯了。我们都司空见惯了那种“违者罚款”的告示牌。（“司空见惯”的意思是形容经常看到不足为奇的事物。后面不能带宾语。） 12.月白风清：形容月夜的明朗幽静。例句：这是一个月白风清的良宵，校园散步的人三三两两从我身边走过。 13.脍炙人口：本指美味人人都爱吃，现比喻好的诗文或事物人人都称赞。例句：我国古典诗歌内蕴丰富，很能激发人们的联想和想象。“日出江花红胜火，春来江水绿如蓝”，吟咏这脍炙人口的诗句，谁不为春回大地后祖国母亲多姿多彩的面貌而自豪。历史是一面脍炙人口的镜子，面对它，我会正衣冠，知兴替，明得失。（指美味人人爱吃。比喻好的诗文受到人们和称赞和传讼。不能修饰“镜子”） 14.鲁殿灵光：汉代鲁恭王建有灵光殿，屡经战乱而岿然独存。后用来称硕果仅存的人或事物。

新视野大学英语第一册Unit 1课文翻译

新视野大学英语第一册Unit 1课文翻译学习外语是我一生中最艰苦也是最有意义的经历之一。虽然时常遭遇挫折，但却非常有价值。我学外语的经历始于初中的第一堂英语课。老师很慈祥耐心，时常表扬学生。由于这种积极的教学方法，我踊跃回答各种问题，从不怕答错。两年中，我的成绩一直名列前茅。到了高中后，我渴望继续学习英语。然而，高中时的经历与以前大不相同。以前，老师对所有的学生都很耐心，而新老师则总是惩罚答错的学生。每当有谁回答错了，她就会用长教鞭指着我们，上下挥舞大喊：“错！错！错！” 没有多久，我便不再渴望回答问题了。我不仅失去了回答问题的乐趣，而且根本就不想再用英语说半个字。好在这种情况没持续多久。到了大学，我了解到所有学生必须上英语课。与高中老师不同，大学英语老师非常耐心和蔼，而且从来不带教鞭！不过情况却远不尽如人意。由于班大，每堂课能轮到我回答的问题寥寥无几。上了几周课后，我还发现许多同学的英语说得比我要好得多。我开始产生一种畏惧感。虽然原因与高中时不同，但我却又一次不敢开口了。看来我的英语水平要永远停步不前了。直到几年后我有机会参加远程英语课程，情况才有所改善。这种课程的媒介是一台电脑、一条电话线和一个调制解调器。我很快配齐了必要的设备并跟一个朋友学会了电脑操作技术，于是我每周用5到7天在网上的虚拟课堂里学习英语。网上学习并不比普通的课堂学习容易。它需要花许多的时间，需要学习者专心自律，以跟上课程进度。我尽力达到课程的最低要求，并按时完成作业。我随时随地都在学习。不管去哪里，我都随身携带一本袖珍字典和笔记本，笔记本上记着我遇到的生词。我学习中出过许多错，有时是令人尴尬的错误。有时我会因挫折而哭泣，有时甚至想放弃。但我从未因别的同学英语说得比我快而感到畏惧，因为在电脑屏幕上作出回答之前，我可以根据自己的需要花时间去琢磨自己的想法。突然有一天我发现自己什么都懂了，更重要的是，我说起英语来灵活自如。尽管我还是常常出错，还有很多东西要学，但我已尝到了刻苦学习的甜头。学习外语对我来说是非常艰辛的经历，但它又无比珍贵。它不仅使我懂得了艰苦努力的意义，而且让我了解了不同的文化，让我以一种全新的思维去看待事物。学习一门外语最令人兴奋的收获是我能与更多的人交流。与人交谈是我最喜欢的一项活动，新的语言使我能与陌生人交往，参与他们的谈话，并建立新的难以忘怀的友谊。由于我已能说英语，别人讲英语时我不再茫然不解了。我能够参与其中，并结交朋友。

新大学日语阅读与写作1 第3课译文

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