Toric intraocular lens versus opposite clear corneal incisions to correct astigmatism in eyes having cataract surgery

Purpose

To compare toric intraocular lens (IOL) implantation with paired opposite clear corneal incisions (OCCIs) for astigmatism correction in patients having cataract surgery.

Setting

Ophthalmology Service, Donostia Hospital, San Sebastián, Spain.

Methods

This randomized prospective clinical study comprised eyes with more than 1.00 diopter (D) of preexisting corneal astigmatism. One group had AcrySof toric IOL implantation and the other, paired 2.75 mm/3.20 mm OCCIs in the steep axis with spherical IOL implantation. Uncorrected (UCVA) and best corrected (BCVA) visual acuity, refraction, corneal and total higher-order aberrations (HOAs), photopic and mesopic contrast sensitivity, and toric IOL axis were measured 3 months postoperatively.

Results

Forty eyes (40 patients) were evaluated. In the toric group, 95% of eyes achieved 20/40 or better UCVA and 70%, 20/25 or better. In the OCCI group, 80% of eyes achieved 20/40 or better UCVA and 50%, 20/25 or better. All eyes achieved 20/25 or better BCVA. Mean refractive cylinder decreased significantly from preoperatively to postoperatively (−1.75 ± 0.71 to −0.62 ± 0.46 D, toric group; −1.61 ± 0.67 to −0.97 ± 0.51 D, OCCI group) (P<.01). In the toric group, 95% and 100% of eyes were within ±0.50 D for J₀ and J₄₅, respectively. In the OCCI group, the percentages were 70% and 100%, respectively. No significant differences in HOA were found between groups (P>.1). Contrast sensitivity was similar except at the highest spatial frequency, being better in the toric group (P<.01).

Conclusion

Toric IOL implantation achieved a slight enhanced effect over OCCIs in treating preexisting astigmatism.