IOL Insertion/Toric IOLs

Outcomes Not Improved With Use of Image-Guided System in Combination With Intraoperative Aberrometer in Correcting Astigmatism

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Use of an image-guided system in combination with intraoperative aberrometer did not significantly improve outcomes compared with standard of care when correcting astigmatism using toric intraocular lenses (IOLs) or corneal incisions, according to a study in the Journal of Cataract & Refractive Surgery.

In this prospective case series, contralateral eyes of patients having uncomplicated bilateral cataract surgery and astigmatism correction were randomly assigned to receive the standard of care (Group A) or preoperative planning using an image-guidance system, intraoperative aberrometry, and femtosecond laser-assisted cataract surgery (Group B). Residual refractive astigmatism at 3 months was the primary endpoint.

Toric IOLs (n = 38) resulted in almost 0.25 diopter (D) less cylinder than corneal astigmatic incisions (n = 40) (P < 0.01). There was no difference between groups (P = 0.41). There was no statistically significant difference in the mean spherical equivalent refraction by group (P = 0.51).

At 3 months follow-up, the IOL in 2 eyes in Group A and 2 eyes in Group B was >10 degrees of absolute orientation from the intended orientation. Compared with optical biometry, mean keratometry was 0.16 D higher with the image-guided system. The vector difference between the two measurements was ≤0.5 D in all eyes.

Combination of an image-guided system and intraoperative aberrometer to correct astigmatism in conjunction with toric IOLs or arcuate incisions did not significantly improve outcomes. The image-guided system and optical biometer were good for corneal astigmatism measurements.


Solomon KD, Sandoval HP, Potvin R. Correcting astigmatism at the time of cataract surgery: Toric IOLs and corneal relaxing incisions planned with an image-guidance system and intraoperative aberrometer versus manual planning and surgery. J Cataract Refract Surg. 2019;45(5):569-575. doi:10.1016/j.jcrs.2018.12.002.

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