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Clinical Outcomes and In Vivo Wavefront Analysis of a Toric Transcleral Plug-Fixated IOL Using a Pyramidal Sensor

Lorenzo de Angelis^1,2, Vito Romano³, Fabrizio Giansanti⁴

¹University of Florence, Italy.

Journal of Cataract and Refractive Surgery

|March 3, 2026

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Sutureless transscleral fixation of a toric intraocular lens (IOL) significantly improved visual acuity and reduced astigmatism in aphakic eyes. This toric IOL offers predictable refractive outcomes for patients lacking capsular support.

Area of Science:

Ophthalmology
Refractive Surgery

Background:

Aphakia, or the absence of a natural lens, often requires intraocular lens (IOL) implantation.
Eyes lacking capsular support present unique challenges for IOL fixation.
Toric IOLs are designed to correct astigmatism, improving visual quality.

Purpose of the Study:

To evaluate visual, refractive, and aberrometric outcomes of a toric FIL-SSF IOL.
To assess the efficacy of this IOL in aphakic eyes without capsular support.

Main Methods:

A prospective observational study involving sutureless transscleral fixation of a toric FIL-SSF IOL in aphakic eyes with corneal astigmatism.
Preoperative and 6-month postoperative assessments included visual acuity, refraction, corneal tomography, and wavefront aberrometry.

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Main Results:

Significant improvements in uncorrected and corrected distance visual acuity were observed (P < .001).
Mean refractive astigmatism decreased substantially, and higher-order aberrations were minimal.
IOL misalignment showed a correlation with residual refractive astigmatism.

Conclusions:

Toric FIL-SSF IOL implantation is effective in improving visual acuity and reducing astigmatism in aphakic eyes lacking capsular support.
The procedure offers predictable refractive outcomes and significant cylinder reduction.