Effect of Anesthesia Technique on the Postoperative Rotational Stability of Toric Intraocular Lenses

To compare the effects of topical versus peribulbar anesthesia on the early rotational stability of toric intraocular lenses (Toric IOLs).

In this prospective cohort study, 240 eyes undergoing phacoemulsification with Toric IOL implantation at Qingdao Eye Hospital were analyzed. Preoperative ocular parameters were recorded. Postoperative outcomes at 1 day, 1 week, and 1 month included Toric IOL rotation, uncorrected distance visual acuity (UDVA), residual astigmatism, intraocular pressure, and the rate of IOL repositioning. Binary logistic regression identified factors associated with repositioning.

Baseline characteristics were similar between groups. On day 1, mean IOL rotation was significantly lower in the peribulbar group (3.61 ± 2.53°) than in the topical group (4.65 ± 5.40°, P=0.003), and UDVA was better (P=0.046). At 1 week, rotation remained smaller in the peribulbar group (P=0.040). By 1 month, no significant differences were found in rotation, UDVA, or residual astigmatism. Repositioning occurred in 1/112 (0.9%) peribulbar and 8/116 (6.9%) topical cases (P=0.034). Logistic regression confirmed anesthesia type as an independent factor for repositioning (P=0.045).

Peribulbar anesthesia enhances early postoperative rotational stability of Toric IOLs and reduces the need for repositioning.