Assessment of toric intraocular lens alignment by a refractive power/corneal analyzer system and slitlamp observation

To assess the validity of an internal optical path difference map of a refractive power/corneal analyzer system in determining the alignment of toric intraocular lenses (IOLs).

Private practices, Spring Hill, Brisbane, and Chermside, Australia.

This retrospective study comprised patients with more than 1.5 diopters of preexisting corneal astigmatism who had phacoemulsification and AcrySof toric IOL implantation. Preoperatively, the surgical eye was marked at the slitlamp microscope using a 4-point technique. The desired IOL orientation was marked with a Mendez marker based on the steep corneal axis. The toric IOL axis was measured 3 weeks postoperatively by rotating the slitlamp beam to align with the IOL axis indicator marks and using the Internal OPD Map on the Nidek OPD-Scan system. Uncorrected (UDVA) and corrected (CDVA) distance visual acuities, residual refractive sphere, and residual keratometric and refractive cylinders were also measured at 3 weeks.

Postoperatively, the mean UDVA was 0.17 logMAR +/- 0.18 (SD) and the mean CDVA, -0.01 +/- 0.12 logMAR; 88.2% of eyes had a UDVA of 0.3 or better, and no eye lost lines of visual acuity. There was an 82.33% reduction in defocus equivalent and a 64.62% reduction in refractive cylinder. The mean IOL misalignment measured by slitlamp was 2.55 +/- 2.76 degrees and by the internal map, 2.65 +/- 1.98 degrees. The correlation between the 2 methods was highly significant (r = 0.99, P<.001).

Both refractive power/corneal analyzer system and slitlamp observation were reliable and predictable methods of assessing IOL alignment. The 4-point preoperative marking technique yielded clinically acceptable, accurate toric IOL alignment.