Long-term astigmatism reduction with toric intraocular lenses: systematic review

This study aimed to assess the long-term effectiveness of toric intraocular lenses (IOLs) in reducing refractive astigmatism (RA) at and beyond 1 year, along with long-term rotational stability and reoperation rates.

Toric IOLs are widely used to correct corneal astigmatism during cataract surgery. However, most reports are limited to early postoperative outcomes.

We conducted a systematic review of long-term outcomes after toric IOL implantation. We searched Ovid Embase and PubMed using the terms "(toric IOL)" AND "(toric intraocular lens)" AND "(long term)" AND "(outcome)" up to April 11, 2025. Studies reporting outcomes of at least 1 year after implantation in otherwise healthy eyes were included. Eyes with ocular comorbidities other than cataracts were excluded. The primary outcomes were residual RA, IOL rotation, and reoperation rates. The study protocol was registered at PROSPERO (CRD420251154641).

19 studies comprising 15 cohorts, 3 case series, and 1 case report totalling 1180 participants and 1564 eyes were analyzed. The mean follow-up period was 29.9 ± 23.7 (range 12 to 96) months. The mean residual cylinder was -0.65 ± 0.39 D at 1 year ( P < .0001) and -0.80 ± 0.54 D ( P = .01) at 2 years. The mean IOL rotation was 2.27 ± 1.40 and 2.82 ± 1.73 degrees at 1 and 2 years, respectively. 12 IOLs (0.77%) required repositioning.

Toric IOL implantation maintains effective astigmatism reduction for up to 2 years. Longer-term data remained scarce. The majority of toric IOLs exhibited excellent rotational stability, and the reoperation rate was low.