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Updated: May 1, 2026

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Accuracy of Toric Intraocular Lens Implantation Using Three-Random-Point Marking Method: A Prospective Pilot Study.

Shuilian Chen¹, Yiliang Liu¹, Fulong Luo^1,2

¹Department of Ophthalmology, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Southern Medical University, Guangzhou, China, fimmu.com.

Journal of Ophthalmology

|April 30, 2026

Summary

The three-random-point (TRP) marking method is more accurate for toric intraocular lens (IOL) positioning than the slit-lamp horizontal meridian (SHM) method. This finding aids in improving surgical outcomes for cataract patients.

Keywords:

axis alignment cataract three-random-point marking toric intraocular lens

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Published on: July 7, 2023

Area of Science:

Ophthalmology
Surgical Technology
Medical Imaging

Background:

Accurate toric intraocular lens (IOL) implantation is crucial for successful cataract surgery outcomes.
Traditional marking methods for IOL alignment, such as the slit-lamp horizontal meridian (SHM) method, may have limitations in precision.

Purpose of the Study:

To compare the accuracy of the three-random-point (TRP) marking method against the SHM marking method for toric IOL positioning.
To evaluate the effectiveness of an image-guided system in enhancing toric IOL placement accuracy.

Main Methods:

Prospective study involving 60 eyes of 54 patients undergoing cataract surgery, randomized into three groups based on surgeon experience and pupil size.
Corneal limbus marking using a staining blunt needle (TRP and SHM methods) followed by measurement with the iTrace system.
Axis deviations were measured using a digital image-guided navigation system.

Main Results:

The TRP marking method demonstrated significantly smaller axis deviations compared to the SHM method across all patient groups (p < 0.05).
Group 1 (novice doctor, dilated pupil): SHM 3.05° ± 2.58° vs. TRP 0.85° ± 0.93°.
Group 2 (novice doctor, small pupil): SHM 2.15° ± 2.35° vs. TRP 1.05° ± 1.57°.
Group 3 (experienced doctor, small pupil): SHM 1.00° ± 1.84° vs. TRP 0.45° ± 1.23°.

Conclusions:

The three-random-point (TRP) marking method, utilizing an iTrace aberrometer and image guidance, is more accurate for toric IOL positioning than the slit-lamp horizontal meridian (SHM) method.
The TRP method offers improved effectiveness in pre-operative planning for toric IOL surgery.
This study provides evidence for adopting advanced marking techniques to enhance surgical precision in toric IOL implantation.