J Korean Ophthalmol Soc.  2017 Nov;58(11):1225-1233. 10.3341/jkos.2017.58.11.1225.

Comparison of Efficacies in Treating Astigmatism between Toric Intraocular Lens Implantation and Limbal Relaxing Incision

• Park Y
• Kim MS
• Kim EC

• KMID: 2395863
• DOI: http://doi.org/10.3341/jkos.2017.58.11.1225

Abstract

PURPOSE
To compare the effectiveness of toric intraocular lens (IOL) implantation and monofocal IOL implantation with a limbal relaxing incision (LRI) for correcting astigmatism in the Korean population.
METHODS
The medical records of 79 patients (100 eyes) with corneal astigmatism over 1.25 diopters (D) who underwent toric IOL implantation (toric group; 54 eyes), monofocal IOL implantation with a concurrent LRI (LRI group; 24 eyes), or monofocal IOL implantation without correcting astigmatism (control group; 22 eyes), were retrospectively reviewed. For subgroup analyses, the three groups were subdivided according to preoperative astigmatic severity under 2.5 D. Visual, refractive, and keratometric outcomes were compared 2 and 6 months postoperatively.
RESULTS
The uncorrected distance visual acuity was at least 20/25 (0.1 logMAR) in 64.8%, 41.7%, and 27.3% of the toric, LRI, and control group eyes, respectively at 2 months after surgery. The toric group had the greatest refractive cylindrical error change (toric group, −2.48 ± 1.84 D to −0.98 ± 0.92 D; LRI group, −2.02 ± 1.03 D to −1.65 ± 0.86 D; control group, −1.69 ± 0.88 D to −1.49 ± 0.60 D; p < 0.001) and the LRI group showed the greatest mean corneal cylindrical error change (toric group, 2.40 ± 1.33 D to 2.23 ± 1.42 D; LRI group, 1.86 ± 0.44 D to 1.29 ± 0.55 D; control group, 1.60 ± 0.39 D to 1.35 ± 0.60 D; p = 0.025). The 85 eyes with moderate corneal astigmatism (between 1.25 D and 2.5 D) were under evaluation. The toric group showed the highest mean refractive cylindrical change (0.97 ± 0.66 D; p < 0.001), followed by the LRI group (0.53 ± 0.87 D; p = 0.046).
CONCLUSIONS
Both surgical techniques significantly reduced astigmatism and had comparable visual outcomes. Toric IOL implantation was more reliable for correcting astigmatism than monofocal IOL implantation with a concurrent LRI regardless of the preoperative astigmatic severity. Both procedures were effective in reducing astigmatism in eyes with moderate corneal astigmatism.

Keyword

Corneal astigmatism; Limbal relaxing incision; Tecnis ZCT toric intraocular lens; Toric intraocular lens implantation

MeSH Terms

Astigmatism*
Humans
Lens Implantation, Intraocular*
Lenses, Intraocular*
Medical Records
Retrospective Studies
Visual Acuity

Figure

• 

  Figure 1 Pre- and postoperative uncorrected distance visual acuity of treatment groups (logMAR). All group showed significant improvement in uncorrected visual acuity. Toric IOL group showed the most difference compared to the other group. POD = postoperative day; M = months; IOL = intraocular lens; LRI = limbal relaxing incision.

• 

  Figure 2 Pre- and postoperative best corrected visual acuity of treatment groups (logMAR). All group showed significant improvement in best corrected visual acuity. POD = postoperative day; M = months; IOL = intraocular lens; LRI = limbal relaxing incision.

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  Figure 3 Pre- and postoperative cylindrical change of treatment groups (n = 100). Positive values represent keratometric astigmatism of each group, and negative values are refractive cylinder. POD = postoperative day; mo = months; IOL = intraocular lens; LRI = limbal relaxing incision.

• 

  Figure 4 Scatter plots of the J0 and J45 vectors (in diopters [D]), calculated by power vector analysis of (A) toric IOL group, (B) LRI group, and (C) control groups. Black diamonds and gray squares indicate preoperative values and 2-months postoperative values, respectively. Preop = preoperative; Postop = postoperative; IOL = intraocular lens; LRI = limbal relaxing incision.

• 

  Figure 5 Pre- and postoperative cylindrical change of treatment groups with keratometric astigmastism under 2.5 D (n = 85). Positive values represent keratometric astigmatism of each group, and negative values are refractive cylinder. POD = postoperative day; mo = months; IOL = intraocular lens; LRI = limbal relaxing incision.

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