Refractive Outcomes After Toric Intraocular Lens Implantation: A Retrospective Study At The National Ophthalmology Unit, Guatemala Low-Income Country

This study aims to evaluate the refractive outcomes of toric IOL implantation in this setting and compare the results with the best available evidence in ophthalmology. Additionally, this study highlights the challenges of accessibility to toric IOLs in Guatemala,  classified as a low-income country by the World Bank, faces significant challenges in providing advanced ophthalmic care. The high cost of toric IOLs, which are significantly more expensive than standard monofocal IOLs, poses a barrier to widespread adoption. Despite these challenges, the National Ophthalmology Unit has made strides in incorporating toric IOLs into its cataract surgery program. 

Study Design: A retrospective descriptive study was conducted at the National Ophthalmology Unit, Guatemala. Data from 33 eyes that underwent toric IOL implantation between May 2024 and February 2025 were analyzed.

Statistical Analysis: Data were analyzed using Python. Paired t-tests were used to compare pre- and postoperative refractive astigmatism and visual acuity. Descriptive statistics were used to summarize complications.

Inclusion Criteria: Patients with preoperative corneal astigmatism ≥ 1.00 D who underwent cataract surgery with toric IOL implantation.

Exclusion Criteria: Patients with ocular comorbidities (e.g., macular degeneration, glaucoma) or incomplete follow-up data.

Surgical Procedure: All surgeries were performed by experienced surgeons using standard phacoemulsification techniques. Toric IOL alignment was performed using manual marking.

Outcome Measures:

Preoperative and postoperative refractive astigmatism.

Preoperative and postoperative LogMAR visual acuity.

Postoperative complications (e.g., axis rotation, posterior capsule opacity).

Demographics: The mean age of patients was 60 years (SD: 12.33).  

Refractive Outcomes:  

• Mean preoperative refractive astigmatism: -3.22 D (SD: 1.46).  

• Mean postoperative refractive astigmatism: -1.05 D (SD: 0.76) (p < 0.001). 

Visual Acuity:  

• Mean preoperative LogMAR: 1.18 (SD: 0.31).  

• Mean postoperative LogMAR: 0.52 (SD: 0.56) (p < 0.001). 

Complications:  

• Axis rotation: 3 cases (9.1%).  

• Posterior capsule opacity: 2 cases (6.1%). 

Toric IOL implantation at the National Ophthalmology Unit, Guatemala, significantly improved refractive outcomes and visual acuity in patients with astigmatism and cataract. The results are comparable to global evidence, reinforcing the efficacy and safety of toric IOLs in cataract surgery. However, accessibility to toric IOLs remains limited in Guatemala due to economic and infrastructural challenges. Expanding access to this transformative technology requires concerted efforts from governments, international organizations, and the ophthalmic community. Future studies with larger sample sizes and longer follow-up periods are recommended to further validate these findings.