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.