Outcomes Of Toric Intraocular Lens Implantation In Cataract Patients With Irregular Corneal Astigmatism

To evaluate the visual and refractive outcomes of toric intraocular lens (IOL) implantation in cataract patients with irregular corneal astigmatism.

Department of Ophthalmology, Chang Gung Memorial Hospital, Linko, Taoyuan, Taiwan.

This retrospective cohort study included 21 eyes from 20 patients who underwent uncomplicated phacoemulsification with toric IOL implantation between August 2020 and March 2023. Patients were diagnosed with irregular corneal astigmatism using corneal topography (Bogan’s definition). Preoperative and postoperative assessments included uncorrected distance visual acuity (UDVA), corrected distance visual acuity (CDVA), refractive astigmatism, and toric IOL axis alignment. Refractive and topographic outcomes were analyzed using Alpins vector analysis, and statistical comparisons were performed with SPSS and Python.

At the 6-month follow-up, mean UDVA improved from 1.09 ± 0.52 logMAR preoperatively to 0.37 ± 0.28 logMAR (P < .01), and mean CDVA improved from 0.68 ± 0.51 logMAR to 0.20 ± 0.21 logMAR (P < .01). Thirteen eyes (62%) achieved UDVA ≥ 20/40, and 18 eyes (86%) achieved CDVA ≥ 20/40. The mean number of gained lines of UDVA and CDVA were 6.62 ± 4.67 and 4.36 ± 3.94, respectively. The mean spherical equivalent improved from -2.51 ± 4.93 D to -0.54 ± 1.03 D (P = .12), and refractive astigmatism decreased from -4.14 ± 2.10 D to -1.72 ± 1.06 D (P < .01). Fourteen eyes (67%) had a refractive cylinder ≤ 2.0 D, while six eyes (29%) had ≤ 1.0 D. Corneal astigmatism remained stable postoperatively.

Toric IOL implantation significantly improved visual acuity and reduced refractive astigmatism in patients with irregular corneal astigmatism, with most achieving satisfactory visual outcomes. Toric IOL implantation may offer benefits for cataract patients who have marked corneal irregular astigmatism.