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PURPOSE: To investigate the accuracy of 3 distinct postoperative toric intraocular lens (TIOL) rotational stability measurement methods. SETTING: Department of Ophthalmology and Optometry, Medical University of Vienna, Vienna, Austria. DESIGN: Single-center, prospective, interventional clinical trial. METHODS: 128 eyes of 81 patients with age-related cataract received a hydrophobic acrylic TIOL Clareon CNW0T3-9. To evaluate rotational stability, 3 distinct assessment methods were used: (Rotix) comparing the TIOL axis at the end of surgery (EoS) with 1 week and 6 months postoperatively using reference vessels at the sclera, (Slitlamp) comparing the intended axis (IA) with the axis at 1 week and 6 months using slitlamp photography using the horizontal axis as a reference, and (Casia) comparing the IA with the axis at 1 week and 6 months using the axis determination tool of a swept-source anterior segment optical coherence tomographer (Casia 2). RESULTS: Mean absolute rotation from EoS/IA to 6 months differed significantly among Rotix (1.33 ± 1.99 degrees 0.01; 19.80), Casia (2.88 ± 2.64 degrees 0.00; 19.00), and Slit-lamp (4.38 ± 3.38 degrees 0.02; 19.38), as indicated by the Friedman test (χ 2 = 71.852, P < .001). Bland-Altman coefficients of repeatability (CoRs) indicated the closest agreement of results between Casia and Rotix, with a CoR of ±3.95 degrees, followed by Slit-lamp and Casia (±6.82 degrees), and finally, between Slit-lamp and Rotix (±7.19 degrees). CONCLUSIONS: When assessing true TIOL rotational stability, it is imperative to use fixed anatomical landmarks as a reference and establish a baseline at the EoS. When assessing TIOL rotation along the horizontal axis, considering cyclorotation of the eye is crucial and must not be underestimated.
Lisy et al. (Wed,) studied this question.