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Aspheric toric IOL improves VA despite significant postop rotation
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An aspheric toric IOL and aspheric non-toric IOL combined with an opposite clear corneal incision reduced cylinder in eyes with low to moderate corneal astigmatism, according to study results.
The prospective, randomized study included 39 eyes of 39 patients; mean age was 70.1 years. Eighteen eyes were implanted with a Lentis Unico L-312T aspheric toric IOL (Oculentis) and 21 eyes were implanted with a Lentis Unico L-312 aspheric non-toric IOL combined with an opposite clear corneal incision. Researchers performed corneal tomography and keratometry at 1 hour, 1 week, and 3 and 9 months after surgery.
Mean preoperative corneal astigmatism was 1.69 D in the toric IOL group and 1.67 D in the non-toric IOL group. At 3 months postoperatively, mean corneal astigmatism was significantly reduced to 0.18 D in the toric IOL group and 0.67 D in the non-toric IOL group, according to the researchers.
Additionally, the researchers found mean uncorrected distance visual acuity was significantly better in the toric IOL group than in the non-toric group, at 0.09 in the toric group and 0.29 in the non-toric group.
Mean corrected distance visual acuity was −0.03 D in the toric IOL group and 0.08 in the non-toric IOL group, which was not considered statistically significant.
Mean absolute IOL misalignment in the toric IOL group was 4.66° at 1 hour, 13.59° at 3 months and 19.9° at 9 months.
Disclosure: The authors have no relevant financial disclosures.
Perspective
Back to TopJay S. Pepose, MD, PhD
The authors performed a prospective, randomized study comparing the performance of an aspheric toric IOL to that of an aspheric non-toric IOL coupled with an opposite clear corneal incision in patients with between 1 D and 2.5 D of pre-existing corneal astigmatism. The interpretation of the study is limited by 30% of patients lost to follow-up, 36.8% of toric IOL patients with more than 5° and 5.3% with more than 40° of rotation from day 1 to 9 months, and the rather large range of pre-existing corneal astigmatism in the inclusion criteria that could impact individual results. Apparently, the Lentis Unico L-312T toric IOL (Oculentis) has been removed from the market due to rotational instability. The results reflect how factors such as surgically induced astigmatism and posterior corneal astigmatism can present challenges in surgical planning. Their variability can result in surprising outcomes, particularly in patients with low pre-existing corneal astigmatism, as shown here in the number of patients with good uncorrected vision despite substantial toric IOL rotation.
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