Refractive Outcomes of Toric Intraocular Lenses in Combined Phacoemulsification and Trabeculectomy Surgery

Précis: Toric intraocular lenses provided accurate astigmatic correction and favourable visual outcomes in combined Phacotrabeculectomy when a standardized trabeculectomy technique was used, minimizing refractive unpredictability traditionally associated with glaucoma surgery. Purpose: To evaluate the visual and refractive outcomes of toric intraocular lenses (IOLs) implanted during combined phacoemulsification and trabeculectomy using a standardized surgical technique. Patients and Methods: This was a combined retrospective and prospective interventional case series involving 70 eyes of patients with primary open-angle or angle-closure glaucoma and visually significant cataract with regular corneal astigmatism ≥0.75 D. All surgeries were performed by a single surgeon, using a standardized trabeculectomy technique and image-guided toric IOL alignment. Visual acuity, manifest refraction, intraocular pressure (IOP), and number of antiglaucoma medications (AGMs) were assessed preoperatively and at 1 and 3 months postoperatively. Vector analysis of astigmatism was performed using the Alpins method. Results: Mean age was 70.06±9.97 years; mean follow-up was 9.33 months. UCVA improved significantly from baseline to 0.24 log MAR at 1 month and 0.18 at 3 months ( P <0.001). Mean absolute residual cylinder was 0.21±0.52 D at 3 months. At 3 months, 80% had no manifest cylindrical error, and 91.4% had residual cylinder <1.00 D. Mean IOP reduced from 16.04±5.56 mmHg preoperatively to 12.54±3.12 mmHg at 3 months ( P <0.001). Mean number of AGMs decreased from 2.47±1.06 to 0.47±0.81 ( P <0.001). Vector analysis showed mild overcorrection and high alignment accuracy. Conclusion: Toric IOLs offer safe and effective astigmatism correction in combined Phacotrabeculectomy when performed using a standardized technique, with visual and refractive outcomes comparable to standalone cataract surgery.