Tonic intraocular lens implantation versus astigmatic keratotomy to correct astigmatism during phacoemulsification

PURPOSE: To compare toric intraocular lens (100 implantation and astigmatic keratotomy (AK) in correction of astigmatism during phacoemulsification. SETTING: Tertiary care hospital. DESIGN: Prospective randomized trial. METHODS: Consecutive patients with visually significant cataract and moderate astigmatism (1.25 to 3.00 diopters [D]) were randomized into 2 groups. Temporal clear corneal 2.75 mm phacoemulsification with toric IOL implantation was performed in the toric IOL group and with 30-degree coupled AK at the 7.0 mm optic zone in the keratotomy group. The uncorrected (UDVA) and corrected (CDVA) distance visual acuities, refraction, keratometry, topography, central corneal thickness, and endothelial cell density were evaluated preoperatively and 1 day, 1 week, and 1 and 3 months postoperatively. RESULTS: The study enrolled 34 eyes (34 patients), 17 in each group. There was no difference in UDVA or CDVA between the 2 groups at any follow-up visit. The mean preoperative and postoperative refractive cylinder was 2.00 D +/- 0.49 (SD) and 0.33 +/- 0.17 D, respectively, in the toric IOL group and 1.95 +/- 0.47 D and 0.57 +/- 0.41 D, respectively, in the keratotomy group (P=.10). The mean residual astigmatism at 3 months was 0.44 +/- 1.89 @ 160 in the toric IOL group and 0.77 +/- 1.92 @ 174 in the keratotomy group (P=.61). All eyes in the toric IOL group and 14 eyes (84%) in the keratotomy group achieved a residual refractive cylinder of 1.00 D or less (P=.17). CONCLUSION: Toric IOL implantation was comparable to AK in eyes with moderate astigmatism having phacoemulsification.(c) 2014 ASCRS and ESCRS