A CLINICAL STUDY TO EVALUATE THE RESULTS OF TORIC INTRAOCULAR LENS IMPLANTATION IN THE MANAGEMENT OF CORNEAL ASTIGMATISM IN CATARACT SURGERY
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Keywords
Toric intraocular lens, cataract surgery, corneal astigmatism, visual acuity, rotational stability
Abstract
Background: Preexisting corneal astigmatism is a common challenge in cataract surgery, often necessitating precise surgical planning to achieve optimal postoperative vision. Toric intraocular lens (IOL) implantation has emerged as an effective option to correct astigmatism during phacoemulsification.
Aim: To evaluate the visual outcomes, astigmatism reduction, and rotational stability of toric IOLs in patients undergoing cataract surgery.
Methods: This prospective observational study included 50 eyes of 50 patients with visually significant cataract and ≥1.0 dioptre (D) of corneal astigmatism. Preoperative assessment included uncorrected visual acuity (UCVA), best-corrected visual acuity (BCVA), keratometry, spherical equivalent, and axial length measurement. Toric IOL selection and alignment were guided by standard toric calculators. Postoperative evaluations were conducted on day 1, at 1 month, and at 3 months, recording UCVA, BCVA, residual astigmatism, and IOL rotation.
Results: The mean age was 63.16 years (range 48–84), with a nearly equal gender distribution (48% males, 52% females). Mean preoperative UCVA improved from 0.74 ± 0.14 logMAR to 0.31 ± 0.13 logMAR in 3 months, while BCVA improved from 0.54 ± 0.14 logMAR to 0.22 ± 0.10 logMAR. At final follow-up, 68.0% of eyes achieved UCVA ≤ 0.2 logMAR. Mean preoperative keratometric astigmatism (2.78 ± 1.05 D) reduced to 0.46 ± 0.19 D, with a mean astigmatism reduction of 2.32 ± 1.02 D. Mean IOL rotation was 2.27°, with no cases exceeding 10°. Lower preoperative astigmatism and minimal postoperative rotation were significantly associated with better residual astigmatism and visual outcomes (p < 0.05). Eyes with residual astigmatism ≤0.50 D had markedly better UCVA compared to those with higher residual astigmatism (p = 0.003).
Conclusion: Toric IOL implantation during cataract surgery provides significant improvement in visual acuity and effective reduction of preexisting corneal astigmatism, with excellent rotational stability. Careful patient selection, accurate IOL alignment, and maintenance of postoperative stability are crucial for achieving optimal refractive and visual results.
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Dr Indu Pandey
(Chief & Corresponding Author) Senior Consultant, MS Ophthalmology, FRCS (Glasgow, UK), MRCSEd, FICO(UK), Department of Ophthalmology, Jagjivanram Railway Hospital, Mumbai
Dr Tarachand Sharma
Ex HOD & Consultant Ophthalmologist, MS Ophthalmology, Jagjivanram Hospital, Mumbai
Dr Pooja Kanodia
MBBS, MS Ophthalmology, Professor, Prasad institute of medical sciences, Lucknow