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Namrata Sharma, Ritu Nagpal, Rajesh Sinha, Jeewan S Titiyal, Rasik Behari Vajpayee; Comparison of toric intraocular lens and monofocal IOL implantation followed by photorefractive keratectomy in pre-existing astigmatism with cataract. Invest. Ophthalmol. Vis. Sci. 2014;55(13):4197.
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© ARVO (1962-2015); The Authors (2016-present)
To compare outcomes of toric intraocular lens (TIOL) implantation and monofocal intraocular lens (MIOL) followed by photorefractive keratectomy ( PRK) in cases of pre-existing astigmatism with cataract .
60 eyes of 52 patients with age related cataract and regular corneal astigmatism between 1.5 to 3.0D underwent phacoemulsification with TIOL implantation (TIOL group,n=30) or phacoemulsification with MIOL placement followed by PRK 3 months later(MIOL+PRK group,n=30).Parameters analysed were uncorrected best corrected visual acuity (UCVA), best corrected visual acuity (BCVA), manifest refraction, contrast sensitivity, glare, aberrations, keratometry and corneal topography.
Mean UCVA in TIOL group was 0.08 ± 0.09 logMAR and in MIOL+ PRK group was 0.07 ± 0.08 logMAR at 6 months (p=0.6). 53.3% patients in the former and 60% in latter group had UCVA > 20/20. Median BCVA values were comparable among the two groups. Median refractive cylinder values at 1 and 3 months were comparable but at 6 months it was -0.5 in TIOL and 0 in MIOL+PRK group (p= 0.02). Mean refractive cylinder at 6 months was -0.35 ± 0.26 D in TIOL and -0.19 ± 0.23 D in MIOL+PRK group. Mean spherical equivalent at 6 months was -0.12 ± 0.3 D in TIOL and -0.09 ± 0.3 D in MIOL+PRK group. Mean log contrast sensitivity was 1.5 ± 0.05 in TIOL and 1.58 ± 0.061 in MIOL+PRK group (p = 0.5).Mean glare acuity value at 6 months was 0.4 ± 0.1 in TIOL group and 0.7 ± 0.1 in MIOL+PRK group (p = 0.001). Root mean square value (RMS) of total aberrations at 5 mm pupil was 1.0 ± 0.4 microns in the former and 1.2 ± 0.5 microns in the latter (p = 0.04) and RMS at 6 mm pupil was 1.2 microns and 1.82 microns respectively (p = 0.01). Mean toric IOL rotation at 1 month was 1.13 ± 1.9 degrees. Mean SIA was 0.53 ± 0.15 D in TIOL and 0.54 ± 0.11 D in MIOL+PRK group at 1 month (p = 0.8). Power vector analysis showed significant difference in the median JO vector value at 6 months (-0.11 in TIOL and 0 in MIOL+PRK group with p = 0.001). Median J45 vector values were comparable. Mean epithelial healing time was 4.6 ± 0.8 days post PRK. None of the patients developed corneal haze following PRK.
TIOL implantation is a safer option with superior visual outcomes as compared to MIOL implantation followed by PRK
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