Comparative Outcomes of Robotic Laser Arcuate Keratotomy and Toric Intraocular Lenses for the Management of Lower Magnitude Astigmatism at the Time of Cataract Surgery

To compare refractive and visual outcomes between robotic laser-assisted arcuate keratotomy (AK) guided by the Wörtz-Gupta FormulaTM and low-power toric intraocular lens (IOL) implantation using the Barrett Toric Calculator for the management of low-magnitude regular corneal astigmatism during cataract surgery. This retrospective, single-surgeon case series included 105 eyes with robotic laser-assisted AK using the ALLY platform with iris registration (LENSAR, Inc, Orlando, FL), and 53 received a toric IOL, using ALLY's IntelliAxis refractive capsulorhexis for intraoperative toric IOL alignment. The primary outcome measure was postoperative residual refractive cylinder at postoperative week 4. Secondary outcomes included uncorrected distance visual acuity (UDVA), best-corrected distance visual acuity (CDVA), and spherical equivalent (SE) refraction. Subgroup analyses evaluated outcomes by astigmatism orientation (with-the-rule [WTR] versus against-the-rule [ATR]). Postoperative residual refractive cylinder did not differ significantly between groups (-0.14 ± 0.16 D AK vs -0.21 ± 0.28 D toric, p = 0.103), nor did SE refraction (-0.08 ± 0.32 D AK versus -0.11 ± 0.28 D toric, p = 0.361), UDVA (0.05 ± 0.08 logMAR both groups, p = 0.507), or CDVA (-0.006 logMAR AK versus -0.004 logMAR toric, p = 0.623). More than 90% of eyes in both cohorts achieved ≤0.50 D of residual astigmatism, and ≥87% attained UDVA of 20/25 or better. Subgroup analyses by astigmatism orientation showed no statistically significant differences in residual cylinder, SE, or VA. In eyes with low-magnitude regular corneal astigmatism undergoing cataract surgery, robotic laser-assisted AK guided by the Wörtz-Gupta FormulaTM achieved non-infereior refractive and visual outcomes to those of low-power toric IOL implantation.