Postoperative Rotation and Refractive Efficacy of Toric Intraocular Lenses After Phacoemulsification Cataract Surgery

We evaluated the rotational stability and factors associated with it in patients implanted with Eyecryl™ roric IOL after phacoemulsification surgery. We also assessed the factors associated with refractive efficacy in these patients.

The present study is a secondary analysis to study the rotation in 121 eyes from 94 patients. We included the following data: demographics; preoperative refraction and corrected distance visual acuity (CDVA), type of astigmatism, axial length, anterior chamber depth, and aqueous depth; power of the implanted IOL, axis of the implanted IOL, and predicted residual error; magnitude and direction of postoperative rotation of the IOL; postoperative vision and refraction (day 30 ± 3 days).

About 86% of the eyes had postoperative astigmatism of ≤ 0.25 D and 9% had 0.26 to 0.50 D on day 30. The median (IQR) rotation of the IOL on day 30 (± 3 days) was 1 (1, 3) degree and the mean (SD) rotation was 2.31 (2.97) degrees. Eyes with high rotation had significantly higher median (IQR) preoperative sphere (more positive side) (1.50 D [0, 1.75] vs 0 D [- 1.0, 0.75]; p = 0.013) and lower mean (SD) axial length (22.6 [0.9] vs 23.2 [0.9]; p = 0.02). The mean (SD) postoperative refractive efficacy was 85.1 (13.6) %; it was significantly lower in those who had with-the-rule astigmatism compared with against-the-rule astigmatism (69.6% vs 86.7%; p = 0.046). The proportion of eyes with difference in lines between postoperative UDVA and CDVA was significantly higher in those with low postoperative efficacy (70.0% vs 21.8%; p < 0.001).

The Eyecryl™ toric intraocular lens had low rotation at 1-month post-surgery. Higher rotation was associated with a higher preoperative sphere (more positive side) and shorter eyes. Postoperative efficacy was higher in eyes with against-the-rule astigmatism. Eyes with < 75% efficacy and/or ≥ 5° rotation showed over-correction on vector analysis.