Itrace ora6/27/2023 However, patients undergoing premium IOL implantation such as multifocal IOLs may not tolerate residual astigmatism of even <1 D and a toric multifocal IOL may be required in such cases.Ī comprehensive ocular examination should be undertaken to rule out any ocular comorbidities that may interfere with the postoperative outcomes. For statements that are frequently mentioned in the literature, we chose the earliest publication and other important articles. All articles were reviewed since the first use of toric IOLs in 1992. Abstracts of relevant non-English articles were used. The relevant references cited in those articles were also searched. The literature search was performed in MEDLINE using “toric intraocular lenses,” “astigmatism,” and “cataract surgery” as keywords. This review provides a comprehensive overview of toric IOLs along with the preoperative planning, various marking methods, intraoperative alignment, and postoperative management to achieve optimal outcomes. Technological advancements in terms of IOL material as well as design have resulted in better rotational stability and precise visual outcomes. In these cases, toric IOLs help to achieve postoperative spectacle independence and optimal patient satisfaction. A preoperative corneal astigmatism of 1 D or more may be present in up to one-third of the cases undergoing cataract surgery, with 22% having more than 1.5 D of astigmatism and 8% having more than 2.0 D of astigmatism. Since then, the increased predictability and enhanced safety of toric IOL implantation has firmly established it as the procedure of choice to correct significant corneal astigmatism in cases undergoing cataract surgery. as 3-piece nonfoldable polymethyl methacrylate implants to be inserted through a 5.7 mm incision. Toric intraocular lenses (IOLs) were first introduced in 1992 by Shimizu et al. Newer toric IOLs have enhanced rotational stability and provide precise visual outcomes with minimal higher order aberrations. Realignment of the toric IOL is needed in 0.65%–3.3% cases, with more than 10° of rotation from the target axis. Postoperative toric IOL misalignment is the major factor responsible for suboptimal visual outcomes after toric IOL implantation. Conventional manual marking has given way to image-guided systems and intraoperative aberrometry, which provide a mark-less IOL alignment and also aid in planning the incisions, capsulorhexis size, and optimal IOL centration. An ideal IOL power calculation formula should take into account the surgically induced astigmatism, the posterior corneal curvature as well as the effective lens position. ![]() The importance of posterior corneal curvature is increasingly being recognized in various studies, and newer investigative modalities that account for both the anterior and posterior corneal power are becoming the standard of care. Enhanced accuracy of keratometry estimation may be achieved by taking multiple measurements and employing at least two separate devices based on different principles. The outcomes after toric IOL implantation are influenced by numerous factors, right from the preoperative case selection and investigations to accurate intraoperative alignment and postoperative care. Comprehensive literature search was performed in MEDLINE using “toric intraocular lenses,” “astigmatism,” and “cataract surgery” as keywords. Toric intraocular lenses (IOLs) are the procedure of choice to correct corneal astigmatism of 1 D or more in cases undergoing cataract surgery.
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