Comparison Of Visual And Refractive Outcomes After Toric Intraocular Lens Implantation Between Residents And Cataract And Refractive Surgery Specialists

To evaluate and compare best corrected visual acuity (BCVA), refractive astigmatism, pre-existing corneal astigmatism, and sphero-cylindrical refractive error improvement with toric intraocular lens (IOL) implantation, between trained residents with an experience of ≥100 phacoemulsification surgeries and cataract and refractive surgery specialists with an experience of ≥2000 phacoemulsification surgeries.

Retrospective observational single-center study that took place in Centro Hospitalar Universitário S. João (Porto, Portugal), a tertiary university hospital.

35 eyes from 32 patients with biometric corneal astigmatism of ≥1.0 diopter (D) who underwent phacoemulsification with IOL implantation between November 2021 and January 2022 were included. All toric IOL calculations were performed using optical biometry (ZEISS IOLMaster®500) and the Barrett toric algorithm. All patients underwent similar uncomplicated surgery with implantation of ALCON® AcrySoft IQ SN6AT toric IOL. Pre and postoperative (6 weeks) BCVA (logMAR scale), refractive astigmatism and sphero-cylindrical refractive error (measured with the TOPCON® KR-800 auto kerato-refractometer) were evaluated. Visual and refractive outcomes were compared according to the type of surgeon (resident vs. cataract and refractive surgery specialist).

20 eyes underwent surgery performed by a resident, while 15 eyes underwent surgery performed by a specialist. Mean refractive astigmatism decreased significantly from 2.12±1.33D to 0.93±0.83D (p=0.014). Mean pre-operative corneal astigmatism was 1.74±0.76D. Comparing pre-operative corneal astigmatism with postoperative refractive astigmatism, there was also a significant improvement (p<0.001). Mean spherical equivalent decreased significantly from 3.12±2.49D to 0.50±0.54D (p=0.003). Mean BCVA improved significantly from 0.42±0.37 logMAR units to 0.17±0.42 logMAR units (p<0.001). The improvements in BCVA (p=0.392), refractive astigmatism (p=0.943) and sphero-cylindrical refractive error (p=0.152) were similar in both groups.

Cataract surgery with phacoemulsification and implantation of toric IOL was effective in improving BCVA, pre-existing regular corneal and refractive astigmatism and sphero-cylindrical refractive error. This improvement was evident and similar in eyes that underwent surgery performed by residents and eyes that underwent surgery performed by specialists.