Comparison Of Immediate Postoperative Supine Posturing And No Posturing On Refractive Astigmatism After Toric Intraocular Lens Implantation

To evaluate the effect of immediate postoperative posturing on refractive astigmatism outcomes following toric intraocular lens (IOL) implantation.

Singapore National Eye Centre, Singapore.

This retrospective audit included 178 eyes of 134 patients who underwent phacoemulsification with Clareon toric IOL implantation between October 2023 to January 2025. Based on surgeon preference, 89 eyes maintained face-up positioning for 30–60 minutes before discharge (posture group), while 89 eyes had no specific positioning instructions (no posture group) post-surgery. Astigmatic outcomes were analyzed using double-angle vector methods via the ESCRS-endorsed Eyetemis tool. The primary outcome was residual refractive astigmatism magnitude. Secondary analysis included vector centroid assessment of postoperative refractive astigmatism. Additionally, subgroup analysis comparing use of digital-IOL marker was performed.

Both groups had similar baseline characteristics, though baseline axial length differed. Mean postoperative residual refractive astigmatism was lower in the posture group (0.520±0.366 D vs 0.683±0.488 D) (p=0.040). Mean prediction error vector magnitude (centroid) was 0.139 D versus 0.236 D, representing 41% reduction in systematic error. Standard deviation was 0.345 D versus 0.456 D (24% reduction in random variability). Mean absolute prediction error was 0.497 D versus 0.658 D. More eyes achieved prediction error ≤0.50 D (57.3% vs 44.9%) and ≤1.00 D (93.3% vs 79.8%). Vector analysis demonstrated a markedly smaller postoperative astigmatism centroid magnitude with digital marking (0.05 D vs 0.21 D), indicating reduced systematic error.

Immediate postoperative positioning was associated with improved astigmatic outcomes. Prospective randomized studies are warranted for further evaluation.