Multifocal toric intraocular lenses versus multifocal intraocular lenses combined with peripheral corneal relaxing incisions to correct moderate astigmatism

Purpose To compare the outcomes of multifocal toric intraocular lens (IOL) implantation and standard nontoric multifocal IOL implantation combined with peripheral corneal relaxing incisions (PCRIs) in patients with moderate preexisting corneal astigmatism. Setting Moorfields Eye Hospital NHS Foundation Trust, London, United Kingdom. Design Prospective randomized controlled trial. Methods Patients with visually significant cataract in both eyes who desired spectacle independence and had corneal astigmatism (1.00 to 2.50 diopters [D]) had multifocal toric IOL implantation in 1 eye and a nontoric multifocal IOL combined with PCRIs (Donnenfeld nomogram) in the contralateral eye. Outcome measures were visual acuity, astigmatic vector reduction, digital toric IOL axis determination, spectacle need, and patient satisfaction. Results Thirty patients were enrolled. Three months postoperatively, the mean residual refractive astigmatism was 0.45 D ± 0.49 (SD) in the toric IOL group and 0.72 ± 0.61 D in the PCRI group. The mean uncorrected distance visual acuity was 0.10 ± 0.14 in the toric IOL group and 0.15 ± 0.14 in the PCRI group and the mean uncorrected near visual acuity, 0.43 ± 0.11 and 0.39 ± 0.10, respectively. The mean absolute misalignment from the intended axis was 2.52 ± 1.97 degrees. The rotation was within ±3 degrees in 90.9% of all cases and within ±6 degrees in all cases. On the questionnaire, 52.9% of all patients said they required spectacles only when reading for a long time. Conclusion Although refractive astigmatism decreased in both groups, multifocal toric IOL implantation was predictable with good rotational stability. Financial Disclosure No author has a financial or proprietary interest in any material or method mentioned.