Toric Intraocular Lens Versus Monofocal Intraocular Lens Implantation and Photorefractive Keratectomy: A Randomized Controlled Trial

Abstract

To compare the outcomes of phacoemulsification with toric intraocular lens implantation vs phacoemulsification with monofocal intraocular lens implantation followed by photorefractive keratectomy (PRK) for correction of pre-existing astigmatism. Randomized controlled trial, 6-month study. setting: Institutional. Sixty eyes of 52 patients with age-related senile cataract and regular corneal astigmatism ranging from 1.50 to 3.00 diopters, enrolled and randomly allocated in 2 groups based on computer-generated random number table. Group 1 patients underwent phacoemulsification with toric intraocular lens (IOL) implantation and Group 2 patients underwent phacoemulsification with monofocal IOL implantation followed by PRK 3months later. The main outcome measures were uncorrected distance visual acuity (UDVA), corrected distance visual acuity (CDVA), residual cylinder, contrast sensitivity, glare acuity, pain score, and higher-order aberrations. At 6months 53.3% of eyes in the toric IOL and 60% eyes in the monofocal IOL with PRK group attained UDVA of 20/20. Median residual refractive cylinder value was higher in the toric IOL group (toric IOL=-0.5, monofocal IOL with PRK= 0; P= .02). Mean root mean square value of total aberrations (5mm pupil) was higher in monofocal IOL with PRK eyes (toric IOL= 1.02 ± 0.44, monofocal IOL with PRK= 1.28 ± 0.5; P= .04). Mean contrast sensitivity values were comparable. Mean toric IOL rotation was 1.3± 2.1 degrees. Mean glare acuity was better in toric IOL eyes (toric IOL= 0.46 ± 0.16, monofocal IOL with PRK= 0.73 ± 0.12; P < .001). Median postoperative pain scores were higher in monofocal IOL with PRK eyes. PRK yields lesser residual cylinder compared to toric IOL. However, it causes greater postoperative pain and corneal aberrations, and poor glare acuity.