Toric intraocular lens rotation to optimize refractive outcome despite appropriate intraoperative positioning

We present 3 eyes of 2 patients who benefitted from toric intraocular lens (IOL) rotation despite appropriate intraoperative positioning. In each case, preoperative astigmatism measurements were obtained by manual keratometry, partial coherence interferometry, and corneal topography. In Case 1, a dramatic shift in corneal topography occurred after surgery, resulting in the need to rotate the toric IOL to maximize the refractive outcome. In Case 2 (both eyes), no significant change in topography occurred, but IOL rotation was required to maximize the refractive outcome despite appropriate IOL alignment based on preoperative measurements. Using an online toric IOL calculator, it was determined that rotation of the IOL would result in significantly improved astigmatic outcomes. At the final evaluation 2 months after IOL rotation, the residual manifest astigmatism was 0.50 diopter (D) in Case 1 and 0 D (right eye) and 0.75 D (left eye) in Case 2. Use of the toric IOL online calculator maximized the uncorrected visual and refractive outcomes.

Neither author has a financial or proprietary interest in any material or method mentioned.