Toric Iol Misalignment After Cataract Surgery

To highlight the impact of toric intraocular lens (IOL) misalignment due to human transcription error in cataract surgery, demonstrating how such errors can significantly affect refractive outcomes.

In a large tertiary ophthalmic centre in London, an elderly patient underwent cataract surgery with toric IOL implantation and required surgical realignment due to a transcription error leading to significant misalignment.

An 85-year-old male presented with persistent visual imbalance following sequential bilateral cataract surgery with toric IOL implantation. Postoperative refraction revealed a marked increase in astigmatism, nearly doubling from preoperative measurements. Examination confirmed the toric IOL was well-centered but misaligned by 90 degrees from its intended axis due to a human transcription error in recording the implantation axis. This misalignment effectively nullified the intended astigmatic correction, worsening the patient’s vision. The patient underwent successful surgical repositioning, realigning the IOL to the correct axis. Postoperatively, his uncorrected visual acuity improved significantly, with resolution of symptoms.

This case underscores the critical impact of human error in toric IOL alignment, demonstrating how a simple transcription mistake can result in a complete reversal of the corrective effect, and even worsening preoperative astigmatism. To prevent such errors, standardized protocols, digital verification systems, and intraoperative alignment checks should be implemented. Surgeons must maintain a high index of suspicion for IOL misalignment in cases of unexpected postoperative refractive surprises, ensuring timely recognition and correction for optimal visual rehabilitation.