Evaluating toric intraocular lens outcomes: A comparison between asymmetric and symmetric bowtie astigmatism

Objectives To compare outcomes of toric intraocular lens (IOL) implantation in patients with asymmetric versus symmetric bowtie astigmatism. Methods This retrospective chart review included 76 eyes from 60 patients: 24 eyes (20 patients) with asymmetric bowtie astigmatism (Group 1) and 52 eyes (43 patients) with symmetric bowtie astigmatism (Group 2). All patients underwent uneventful phacoemulsification with toric IOL implantation. Uncorrected distance visual acuity (UCVA), residual astigmatism, and spectacle independence at three months postoperatively were evaluated. Results The median UCVA was 0.10 logMAR in Group 1 and 0.00 in Group 2 (P = 0.045). UCVA of 20/20 or better was achieved in 29% of Group 1 and 52% of Group 2. The median residual astigmatism was significantly higher in Group 1 (−1.39 D, IQR 1.23) than in Group 2 (−0.70 D, IQR 0.35; P < 0.01). Spectacle-free rates were 88.89% in Group 1 and 81.82% in Group 2 (P = 0.709). Conclusion At three months postoperatively, toric IOL implantation provided comparable UCVA and spectacle independence in both groups, though residual astigmatism was significantly higher in the asymmetric group.