Correction of moderate corneal astigmatism during cataract surgery: Toric intraocular lens versus peripheral corneal relaxing incisions

Abstract

PURPOSE: To compare the astigmatism-reducing effect of a toric intraocular lens (IOL) and peripheral corneal relaxing incisions (PCRIs). SETTING: Moorfields Eye Hospital NHS Foundation Trust, London, United Kingdom. DESIGN: Prospective masked bilateral randomized study. METHODS: Cataract patients with a preoperative corneal astigmatism of 1.0 to 2.5 diopters (D) were included. All patients received a toric IOL in 1 eye and a nontoric IOL plus a PCRI in the other eye. Postoperative follow-up was at 1 hour, 1 month, and 6 months. The uncorrected distance visual acuity, corrected distance visual acuity, autorefraction (Topcon RM-8800), and subjective refraction were recorded. The IOL axis was assessed using retroillumination photographs. RESULTS: The study enrolled 60 eyes of 30 patients. The mean astigmatism vector reduction was 1.74 D ± 0.64 (SD) in the toric IOL group and 1.27 ± 0.76 D in the PCRI group; the difference was statistically significant (P=.042). The mean absolute rotation of the toric IOL was 2.5 ± 1.8 degrees (maximum 6.3 degrees) in the first 6 postoperative months. Astigmatism increased in the PCRI group between the 1-month and 6-month follow-up (mean 0.38 ± 0.27 D; maximum 1.00 D) (P<.001). CONCLUSION: Toric IOLs and PCRIs both reduced astigmatism; however, toric IOLs reduced astigmatism to a higher extent and they were more predictable.