Toric Intraocular Lenses Versus Peripheral Corneal Relaxing Incisions for Astigmatism Between 0.75 and 2.5 Diopters During Cataract Surgery.

PURPOSE

To compare the outcomes after toric intraocular lens (tIOL) or peripheral corneal relaxing incisions (PCRI) for keratometric astigmatism (K) between 0.75 and 2.5 diopters (D) during cataract surgery.

DESIGN

Prospective randomized clinical trial.

METHODS

Eighty eyes (80 participants) received either tIOL or PCRI and were assessed preoperatively, 1, 3, 6, and 12 months postoperatively.

PRIMARY OUTCOME MEASURE

Uncorrected (UCDVA) and best-corrected distance logMAR visual acuity (BCDVA) at 12 months.

SECONDARY OUTCOME MEASURES

Uncorrected near visual acuity (UCNVA), manifest refraction, K and mean keratometry (K), corneal aberrometry, tIOL rotation, and quality-of-life questionnaire.

RESULTS

Comparing tIOLs vs PCRIs, there was no significant difference in the UCDVA, BCDVA, and UCNVA. At 12 months, 61% vs 53% had UDCVA of 20/25 or better, 100% vs 76% gained ≥1 lines, and 59% vs 43% were within ±0.13 D spherical equivalent. In the PCRI group, anterior K decreased at 1 month and remained stable thereafter; there was a nonsignificant trend toward a flatter posterior K and steeper posterior K and the total corneal Z was low at 1 and 12 months. Over 12 months, there were changes in posterior corneal tilt, coma, and hexafoil in the PCRI group. The mean rotation of the tIOLs at 12 months was 1.8 ± 1.4 degrees. tIOL patients were happier and were glad to use the nonprescription sunglasses.

CONCLUSION

There was no difference in visual acuity, although more tIOL patients gained ≥1 line and were within ±0.13 D. After PCRIs, the anterior K decreased in the early postoperative period and remained stable thereafter and posterior corneal aberrations changed constantly over 12 months.