Abstract
BackgroundWith increasing availability of toric intraocular lenses (IOL) for cataract surgery, real-world refractive outcome data is needed to aid the counselling of patients regarding lens choice. We aim to assess the outcomes of toric intraocular lens use in the non-specialist environment of a typical United Kingdom NHS cataract service.MethodsA retrospective cohort study conducted at the Oxford Eye Hospital, Oxford University Hospitals NHS Foundation Trust, UK. All patients who received a toric IOL implant over a 10 months period. Patients underwent pre-operative corneal marking, phacoemulsification and toric IOL implantation. Biometry was obtained using a Zeiss IOLMaster 500 and the toric IOLs were selected using the manufacturers’ online calculators. Post-operative refractions were obtained from optometrist’s manifest refraction or by autorefraction. The outcome measures were post-operative unaided visual acuity (UVA), spherical equivalent refraction, cylindrical correction and all complications.ResultsThirty-two eyes of 24 patients aged 21–86 years (mean 66.4, SD 14.5) were included. UVA was superior to pre-operative best-corrected visual acuity (BCVA) in 81% of eyes, same in 16% and inferior in 3%, resulting in a median improvement of 0.20 LogMAR (IQR 0.10 to 0.30). 56%, 81%, 94% and 100% of eyes were within ±0.5, ±1.0, ±1.5 and ±2.0 D of predicted spherical equivalent, respectively. Three (9%) eyes required further surgery to rectify significant IOL rotation.ConclusionsReduced cylindrical correction and improved UVA could be expected in the majority of patients undergoing toric IOL implantation. Patients should be counselled about the risk of lens rotation.
Highlights
With increasing availability of toric intraocular lenses (IOL) for cataract surgery, real-world refractive outcome data is needed to aid the counselling of patients regarding lens choice
IOL repositioning was performed with final unaided visual acuity (UVA) of 0.60 LogMAR and best-corrected visual acuity (BCVA) of 0.00 LogMAR, consistent with a refractive target of − 2.44 D
The toric IOLs (TIOL) was found to have rotated by 25° immediately after surgery, which recurred despite IOL repositioning twice in quick succession
Summary
With increasing availability of toric intraocular lenses (IOL) for cataract surgery, real-world refractive outcome data is needed to aid the counselling of patients regarding lens choice. Femtosecond laser may be able to create PCRIs with a high degree of precision thereby minimising the risk of corneal perforation, PCRIs could still be associated with the risks of wound gape, corneal infection and nerve damage leading to secondary dry eye [2,3,4] Alternatively, astigmatic correction through excimer laser photorefractive keratectomy could be complicated by refractive error, and all the complications associated with the technique including diffuse lamellar keratitis and corneal haze [5, 6]
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