Visual Outcomes Following Cataract Surgery With Custom-Made Toric IOLs for the Correction of High Corneal Astigmatism

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Purpose: To describe the refractive results of cataract surgery in patients with high corneal astigmatism treated with implantation of custom-made toric intraocular lenses (IOLs). Methods: This retrospective cohort analysis of eyes implanted with high-cylinder (≥6.75 diopters [D]) custom-made toric IOLs was conducted at Rabin Medical Center, Petach Tikva, Israel. A control group of eyes implanted with standard toric IOLs (1.50 to 3.75 D) was also included. Postoperative IOL misalignment, uncorrected distance visual acuity (UDVA), residual refractive astigmatism (RA), and the prediction error (PE) of the toric IOL calculation using the Barrett Toric Calculator were assessed. Results: Twenty-two eyes of 22 patients were included. The mean ± standard deviation toric power was 9.67 ± 3.51 D (range: 6.75 to 19.00 D). Diagnoses included pellucid marginal degeneration (n = 7), keratoconus (n = 4), post-keratoplasty astigmatism (n = 3), and previous pterygium excision (n = 2). The mean postoperative UDVA was 0.28 ± 0.19 logarithm of the minimum angle of resolution (Snellen: 20/38). Mean absolute astigmatism decreased from 7.88 ± 3.15 D preoperatively (corneal) to 0.76 ± 0.87 D postoperatively (refractive) ( P < .001). One eye required redialing due to a 17° misalignment. Compared with the control group (41 eyes), the high-cylinder toric IOL group showed a slightly lower UDVA (20/30, P = .024) and a non-significant trend toward higher RA (0.58 ± 0.50, P = .930), as well as a significantly worse RA-PE, in both vector magnitude (1.47 vs. 0.62, P = .027) and vector dispersion (total bivariate variance 2.67 vs 0.40, px < 0.001 and py = 0.006). Conclusions: Customized high-cylinder toric IOLs significantly improve UDVA and reduce RA in eyes with extreme corneal astigmatism. Although slightly inferior to standard toric IOLs, they provide an effective treatment option for astigmatic correction in complex corneal pathologies with a central and relatively regular astigmatic component.

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