Refractive Outcomes of Toric Intraocular Lenses in Combined Phacoemulsification and Trabeculectomy Surgery

Toric intraocular lenses provided accurate astigmatic correction and favourable visual outcomes in combined phacotrabeculectomy when a standardized trabeculectomy technique was used, minimizing refractive unpredictability traditionally associated with glaucoma surgery.

To evaluate the visual and refractive outcomes of toric intraocular lenses (IOLs) implanted during combined phacoemulsification and trabeculectomy using a standardized surgical technique.

This was a combined retrospective and prospective interventional case series involving 70 eyes of patients with primary open angle or angle closure glaucoma and visually significant cataract with regular corneal astigmatism ≥0.75 D. All surgeries were performed by a single surgeon, using a standardized trabeculectomy technique and image-guided toric IOL alignment. Visual acuity, manifest refraction, intraocular pressure (IOP), and number of antiglaucoma medications (AGMs) were assessed preoperatively and at 1 and 3 months postoperatively. Vector analysis of astigmatism was performed using the Alpins method.

Mean age was 70.06±9.97 years; mean follow-up was 9.33 months. UCVA improved significantly from baseline to 0.24 log MAR at 1 month and 0.18 at 3 months ( P <0.001). Mean absolute residual cylinder was 0.21±0.52 D at 3 months. At 3 months, 80% had no manifest cylindrical error, and 91.4% had residual cylinder <1.00 D. Mean IOP reduced from 16.04±5.56 mmHg preoperatively to 12.54±3.12 mm Hg at 3 months ( P <0.001). Mean number of AGMs decreased from 2.47±1.06 to 0.47±0.81 ( P <0.001). Vector analysis showed mild overcorrection and high alignment accuracy.

Toric IOLs offer safe and effective astigmatism correction in combined phacotrabeculectomy when performed using a standardized technique, with visual and refractive outcomes comparable to standalone cataract surgery.