Improving refractive outcomes of toric intraocular lens implantation for correction of astigmatism during cataract surgery

Abstract EN

Objectives : To evaluate whether updating corneal topography instrumentation and educating surgeons on optimum patient selection can result in improved toric IOL outcome.

Methods : A retrospective file review of patients who underwent cataract extraction and toric IOL placement over four years, between July 2010 and March 2014, at Lahey Clinic Medical Center, USA, was conducted.

The patients were divided into two groups: group 1, those who had surgery between July 2010 and June 2012 and group 2 those who had surgery between July 2012 and March 2014 and the final uncorrected distance visual acuity (UDVA) outcome was compared.

Corneal topography was obtained preoperatively on all patients - prior to June 2012, Nidek and Tomey topographers were primarily used, and after July 2012 Zeiss topographers were primarily used.

In mid-2012, all surgeons in the department were educated on proper interpretation of topographic maps and instructed to avoid toric IOL placement if irregular astigmatism or ocular comorbidities limiting vision were present pre-operatively.

Uncorrected distance visual acuity and residual refractive astigmatism were noted at the 1-month postoperative visit.

Data were sorted into 3 groups – Group 1, are those with good outcomes (UDVA 20/25 or better with 0.5 D or less of residual astigmatism), group 2, are those with fair outcomes (UDVA 20/30 or better with 0.75 or less of residual astigmatism), and group 3 are those with suboptimal outcomes (UDVA 20/40 or worse with 0.75 D or more of residual astigmatism).

Results : One hundred and thirty-three eyes of 96 patients (55 males, 41 females) were assessed between July 2010 and June 2012 (pre-intervention), and 115 eyes of 81 patients (55 males, 26 females) were assessed between July 2012 and March 2014 (post-intervention).

The age range was 50-75 years with an average of 62.5 years.

In the pre-intervention group, 72.9% of eyes had good or fair outcomes and 27% had suboptimal outcomes.

In the post-intervention group, 75.7% of eyes had good or fair outcomes and 24.3% had suboptimal outcomes.

Of the eyes with suboptimal outcomes, ocular comorbidities were present in 50% pre-intervention and in 23% post-intervention.

Conclusions : Despite reduction of toric IOL placement in patients with ocular comorbidities and irregular astigmatism, there was no significant decrease in the rate of suboptimal outcomes after toric IOL placement.

This suggests that other factors may be more important to address, such as improving accuracy of axis marking and alignment..