Visual and refractive outcomes of monofocal toric intraocular lens implantation in amblyopic eyes

Purpose To evaluate the visual and refractive outcomes of monofocal toric intraocular lens (IOL) implantation after cataract surgery in amblyopic eyes Methods Our center's database was used to identify patients who had undergone bilateral cataract surgery between 2016 and 2020 with the implantation of a toric IOL in their amblyopic eye. Exclusion criteria were the presence of strabismus, ocular pathologies other than cataract or intra-surgical complications. The outcomes analysed were uncorrected distance visual acuity (UDVA), subjective refraction and corrected distance visual acuity (CDVA) one month after surgery. Results Ninety patients were included, with a mean age of 68.96 +/- 7.81years. CDVA was lower for the amblyopic eye, both before and after surgery. There was a mean improvement in CDVA of 0.23 +/- 0.21 LogMAR for the dominant eye and of 0.39 +/- 0.33 for the amblyopic eye, p < 0.001 in both cases. Postoperative subjective refractive cylinder was higher in the amblyopic eye (-0.24 +/- 0.39 D versus -0.10 +/- 0.25 D, p < 0.01), as well as mean cylinder prediction error (-0.30 +/- 0.47 D versus 0.02 +/- 0.42 D, p < 0.01), compared to the dominant eye. There was a statistically significant correlation between preoperative and postoperative CDVA in amblyopic eyes (Spearmans Rho = 260, p = 0.013). Mean postoperative UCVA was 0.15 +/- 0.25 for amblyopic and 0.03 +/- 0.12 for dominant eyes. Only one patient required distance spectacle correction due to residual astigmatism. Conclusions Cataract surgery with toric IOL implantation in amblyopic eyes leads to an improvement in visual acuity and to spectacle independence in almost all cases, even in the presence of a higher cylinder prediction error.