Role Of Itrace Aberrometry In Diagnosing Toric Iol Misalignment And Guiding Repositioning

To report a case of postoperative refractive surprise caused by toric intraocular lens (IOL) rotational misalignment and highlight the role of ray-tracing aberrometry (iTrace) in diagnosis and surgical planning.

Private tertiary ophthalmology referral center.

A female patient presented with refractive surprise after uncomplicated cataract surgery with toric IOL implantation. Preoperatively, the visual acuity of the left eye was 0.7 with manifest refraction S−10.00 C−5.00×165. Postoperatively, uncorrected visual acuity was 1.0 but with residual refractive error S+1.75 C−2.50×130. Slit-lamp examination suggested misalignment of the toric IOL axis. iTrace ray-tracing aberrometry was performed to evaluate internal optical aberrations and confirm the source of the residual astigmatism. Surgical repositioning was undertaken using viscodissection of the capsular bag, followed by careful rotation of the IOL to the intended axis based on preoperative calculations and iTrace analysis.

Postoperatively, the patient achieved uncorrected visual acuity of 1.0 with elimination of residual refractive astigmatism. Repeat iTrace analysis demonstrated improved optical quality with resolution of internal astigmatism.

Toric IOL rotational misalignment is a significant cause of postoperative residual astigmatism following cataract surgery. Ray-tracing aberrometry with iTrace enables differentiation between corneal and internal optical components, facilitating accurate diagnosis and surgical planning. Early iTrace-guided IOL repositioning can effectively restore the intended refractive outcome and improve postoperative visual quality. This case highlights the role of ray-tracing aberrometry as an adjunct diagnostic tool for identifying toric IOL misalignment and guiding timely surgical correction.