Purpose: To compare toric intraocular lens (IOL) implantation with arcuate corneal relaxing incisions for moderate to high corneal astigmatism during cataract surgery.
Design: A retrospective comparison study.
Methods: This 12-month single-surgeon study compared eyes with cataract and preexisting astigmatism of 1.75 diopters (D) or greater (range, 1.75-5.25 D) receiving corneal arcuate relaxing incisions or toric IOL implantation. Main outcome measures were visual acuity, refractive results, and IOL axis determination.
Results: There were 45 and 20 eyes in the toric IOL and arcuate incision groups, respectively. Preoperative data were not significantly different between the 2 groups; the mean preoperative astigmatism was 2.16 ± 0.93 D in the toric IOL group and 2.41 ± 0.76 D in the incisional group. At 6 months postoperatively, the mean residual astigmatism was 0.75 and 1.33 D (P = 0.000), respectively; 82.2% and 44.4% of eyes were 1.00 D or less (P = 0.000), and 35.7% and 16.7% of eyes were 0.50 D or less (P = 0.000), respectively. Uncorrected distance visual acuity improved in both groups; eyes in the toric IOL group were more likely to be 20/30 or better (87% vs 29%, P = 0.008). Following surgery, all eyes had best corrected visual acuity of 20/40 or greater, and no eye lost a line of vision. The mean toric IOL rotation was 2.6 ± 1.7 degrees (range, 0-6 degrees).
Conclusions: Both toric IOLs and arcuate corneal incisions reduce moderate to high preexisting corneal astigmatism during cataract surgery; however, toric IOL implantation was more effective and predictable.