Results of higher power toric intraocular lens implantation

PURPOSE: To evaluate the efficacy, predictability, and safety of coaxial microincision phacoemulsification and toric intraocular lens (IOL) implantation in eyes with high corneal astigmatism. SETTING: Two eye clinics in Germany. DESIGN: Case series. METHODS: Routine cataract extraction using 2.2 mm coaxial phaco equipment and Acrysof toric IOL (3.00 to 6.00 diopters [D] cylinder) implantation were performed. Examinations included optical biometry, Haigis IOL calculation, topography, and objective and subjective refractions. Retroillumination images were used to evaluate IOL alignment. Postoperative examinations were scheduled at 1 week and 3 months. RESULTS: The study enrolled 40 eyes (30 patients). The mean preoperative keratometric cylinder was 3.55 ± 0.73 D (range 2.64 to 5.39 D) and the mean 3-month postoperative subjective cylinder, 0.67 ± 0.32 D. The mean logMAR uncorrected distance visual acuity improved from 0.93 to 0.20 and the mean logMAR CDVA, from 0.41 to 0.09. The mean prediction error (spherical equivalent) was +0.14 ± 0.44 D. The mean IOL rotation between 1 week and 3 months was 0.23 ± 1.9 degrees clockwise. The mean surgically induced astigmatism was 0.08 ± 0.41 D. The alignment error was below 10 degrees in 97.5% of cases. The mean vector change in refractive cylinder between 1 week and 3 months was 0.31 ± 0.19 D. The Alpins correction index was +1.01, indicating a slight tendency toward overcorrection. CONCLUSIONS: Coaxial microincision phacoemulsification with toric IOL safely and predictably reduced high corneal astigmatism and improved surgical outcomes. Thorough planning and precise execution are necessary.