A Comparative Study On Visual Outcome And Rotational Stability After Different Toric Intraocular Lens Implantation During Cataract Surgery—A Randomised Controlled Trial

To evaluate comparing the visual acuity and rotational stability of hydrophobic hybrid toric versus hydrophilic toric enhanced depth of focus ( EDOF) intraocular lenses ( IOLs) in patients undergoing cataract surgery with coexisting astigmatism.

Tertiary Eye Hospital and Medical College, Odisha, India

This was a prospective, randomized clinical study on all patients with senile cataract and regular corneal astigmatism who consented for this study undergoing phacoemulsification operated under a single-surgeon during the year 2024-2025. Total of 68 patients were randomized to receive the hydrophobic, Eyehance toric (Group A, n=34) or hydrophilic Rayner toric IOLs (Group B, n=34) undergoing phacoemulsification. Comprehensive postoperative visual acuity, rotational stability and residual astigmatism were evaluated at 1 week, 1 month, and 3 months post-surgery. Patient satisfaction, as measured by a quality-of-life questionnaire, was added to provide a holistic view of treatment success. 

Mean age was 62.9 vs 65.1 years in Group A and B respectively. Best-corrected visual acuity (log MAR) was 0.032+/-0.082 in Group A and 0.034+/-0.077 in Group B at 3 months (p=0.554). Friedman tests compared the  residual astigmatism between time intervals and no significant differences was noted between them (p-values >0.05). On the rotational stability, while significant differences were observed between the time intervals among the hydrophilic group (p = 0.039), no significant differences were observed in the hydrophobic group (p = 0.242). Group A reported 79.4 % of patients were “very satisfied”, and 20.6 % were “fairly satisfied” compared to Group B, 44.1 % were “very satisfied” and 55.9 % were “fairly satisfied.” (p <0.003).

The study provides clear evidence that both IOLs were excellent at delivering vision and reducing residual astigmatism. The hydrophilic acrylic toric IOL had comparable rates of postoperative misalignment and surgical repositioning with the hydrophobic acrylic toric IOL.