Toric Iol Repositioning

To identify toric IOL rotation rates in a real-world setting.

Moorfields Eye Hospital and its outreach sites.

Using the electronic patient record system of Moorfields Eye Hospital, and its outreach sites, we identified eyes that underwent cataract extraction and were implanted with a toric IOL. The only toric lenses used by our centres were Alcon AcrySof® monofocal toric IOLs; specifically, the SN6AT range. We searched our database for all cases in which this lens was inserted during the primary cataract extraction procedure. We then searched for all patients in this group that had a second operation on the same eye at a later date in which the operation note contained the term ‘IOL’. The case notes for this second group were then manually reviewed to identify those in which a reposition surgery was conducted due to IOL rotation.

We identified 3,577 primary cases. All surgeries took place between January 2014 to October 2021. We found that 24 cases underwent secondary surgery to reposition the IOL due to a symptomatic post-operative rotation of the lens. This represents a rate of 0.67%. The repositioning surgery was performed at an average of 49 days (range: 7-172 days) after the primary cataract surgery. The primary surgeries were performed by 369 different surgeons over 11 different sites.

The rotation rate is similar to the small numnber of other large-scale studies published. Good quality consent is important when using toric IOLs. This data allows one to counsel patients pre-operatively and state that approximately ‘1 in 150’ patients go on to have surgery to rotate the lens. We cannot state that this figure is the risk of rotation as a greater number of patients would qualify for a rotation but may chose other management strategies such as conservative management or laser refractive correction.