Visual And Refractive Outcomes Of Cataract Surgery With Toric Lens Implants In Patients With Ocular Comorbidities In A Tertiary Teaching Nhs Hospital In The United Kingdom

Toric intraocular lenses (Toric IOLs) are used to correct corneal astigmatism in patients undergoing cataract surgery. Corneal astigmatism affects about a third of the population and 8% of people present more than 2D of corneal astigmatism. The purpose of this study was to analyse the outcomes of cataract surgery with monofocal toric IOLs in a NHS cohort of patients with mixed ocular comorbidities and to assess the visual benefit of the toric IOLs in cases where the visual prognosis may be guarded due to pre-existing ocular pathologies of mild-moderate severity.

This study was performed in the Ophthalmology Department of King’s College Hospital NHS Foundation Trust.

We conducted a retrospective cohort study using Medisoft electronic records software Audit suite to retrieve clinical information of patients with a corneal astigmatism of 1.5D or greater and underwent cataract surgery with toric IOLs implants over a twelve months period from August 2020 and December 2022. Three authors retrieved data about patient’s demographics, ocular comorbidities, preoperative and postoperative unaided visual acuities and refractive measurements, rate of complications including lens misalignment and returns to theatre. This retrospective study was conducted in accordance with the Declaration of Helsinki and patient’s informed consent was not required as the data were anonymised at the point of data collection.

We collected data on 110 eyes of 100 patients (59.1% females, 40.9% males). The average axial length was 23.64mm, the average preoperative cylinder was -3.06D (range -1.50D to -7.75D) and the average preoperative unaided visual acuity (VA) was 0.532 LogMAR (range 0 – 2.3 LogMAR) . In our cohort, 58.2% patients had no co-existing ocular pathology, 41.8% patients had mild-moderate ocular comorbidities (9% corneal pathology, 15% retinal pathology, 9% primary open angle glaucoma). The average postoperative VA was better than 0.177 LogMAR with a mean improvement of 0.355 LogMAR. Our cohort had no intra or postoperative complications, no returns to theatre to correct misalignment of the toric IOL.

This retrospective study shows that toric IOLs are a safe and effective choice of lens implant for cataract surgery in patients with corneal astigmatism and co-existing ocular ocular pathology. We observed that the correction of corneal astigmatism results in in improved postoperative visual acuity, reduction in cylinder, with no increase in complications in a group of patients with mixed comorbidities. This study suggests that patients with corneal astigmatism over 1.5-2D and co-existing ocular pathology of mild-moderate severity should be considered as suitable candidates for monofocal toric IOL implants.