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. 2022 May 19;12(1):8457.
doi: 10.1038/s41598-022-12426-8.

Long-term outcomes of cataract surgery with toric intraocular lens implantation by the type of preoperative astigmatism

Tetsuro Oshika  1 , Shinichiro Nakano  2 , Yoshifumi Fujita  3 , Yuya Nomura  3 , Yasushi Inoue  4 , Hiroyasu Takehara  4 , Kazunori Miyata  5 , Masato Honbou  5 , Toru Sugita  6 , Tsutomu Kaneko  6
Affiliations

Long-term outcomes of cataract surgery with toric intraocular lens implantation by the type of preoperative astigmatism

Tetsuro Oshika et al. Sci Rep. .

Abstract

Surgical outcomes of toric intraocular lens (IOL) implantation for 8 years after surgery were analyzed. Data were retrospectively collected in 176 eyes of 176 patients before and 1 month, 1, 3, 5, and 8 years after phacoemulsification and implantation of a toric IOL. Preoperative corneal and postoperative manifest astigmatism was analyzed by converting to power vector notations; horizontal/vertical (J0) and oblique (J45) astigmatism components. Toric IOL implantation significantly reduced pre-existing astigmatism by decreasing J0 in eyes with preoperative with-the-rule (WTR) astigmatism, increasing J0 in eyes with against-the-rule (ATR) astigmatism, and correcting J45 in eyes with oblique astigmatism. After surgery, the eyes with preoperative ATR astigmatism showed a significant ATR astigmatic shift, and J0 at 5 and 8 years was significantly smaller than that at 1 month postoperatively. Uncorrected distance visual acuity was also significantly worse at 5 and 8 years than at 1 month postoperatively. In eyes with WTR and oblique astigmatism, the effects of toric IOLs on astigmatism and visual acuity were sustained for 8 years. The long-term astigmatism-correcting effects did not differ among the models of toric IOL used in this study, SN6AT3-8 (Alcon Laboratories). In eyes with preoperative ATR astigmatism, astigmatism-correcting effects of toric IOLs decreased at 5 years and later postoperatively, indicating that overcorrection may be considered at the time of cataract surgery. In eyes with WTR and oblique astigmatism, the effects of toric IOLs were maintained throughout the 8-year follow-up period.

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Conflict of interest statement

Dr. Tetsuro Oshika received compensation as a consultant from Alcon, Johnson & Johnson Vision, Santen Pharmaceutical, and Mitsubishi Tanabe. He receives research support from Santen Pharmaceutical, Tomey, Alcon, Senju Pharmaceutical, Johnson & Johnson Vision, HOYA, KOWA Pharmaceutical, Otsuka Pharmaceutical, Novartis, Pfizer, and Topcon. Other authors do not have any conflict of interest.

Figures

Figure 1
Figure 1
Time course of changes in astigmatism. Toric IOL implantation significantly decreased J0 (p = 0.002), but not J45 (p = 0.902). When postoperative values from 1 month to 8 years were compared, statistically significant changes were found in J0 (p < 0.001) but not in J45 (p = 0.743). The J0 at 5 years (*p = 0.008) and 8 years (**p < 0.001) were significantly smaller than J0 at 1 month postoperatively.
Figure 2
Figure 2
Double-angle plot analyses of preoperative corneal astigmatism (A), manifest astigmatism at 1 month postoperatively (B), and manifest astigmatism at 8 years postoperatively (C). Each ring = 0.5 D.
Figure 3
Figure 3
Time course of changes in astigmatism in eyes with preoperative with-the-rule astigmatism. Toric IOL implantation significantly decreased J0 (p < 0.001), but not J45 (p = 0.782). Postoperative values from 1 month to 8 years were not significantly different in J0 (p = 0.511) and J45 (p = 0.679).
Figure 4
Figure 4
Time course of changes in astigmatism in eyes with preoperative against-the-rule astigmatism. Toric IOL implantation significantly increased J0 (p < 0.001), but not J45 (p = 0.825). When postoperative values were compared, J0 showed significant changes after surgery (p < 0.001), and J0 values at 5 years (*p < 0.001) and 8 years (*p < 0.001) were significantly smaller than that at 1 month postoperatively. The mean J45 remained stable from 1 month to 8 years after surgery (p = 0.964).
Figure 5
Figure 5
Time course of changes in astigmatism in eyes with preoperative oblique astigmatism. Toric IOL implantation significantly increased J45 (p = 0.045), but not J45 (p = 0.912). When postoperative values were compared, J0 (p = 0.972) and J45 (p = 0.189) did not change significantly from 1 month to 8 years.
Figure 6
Figure 6
Time course of changes in J0 by the model of toric IOLs. Postoperative J0 values were not different among the models (p > 0.05).
Figure 7
Figure 7
Time course of changes in J45 by the model of toric IOLs. Postoperative J45 values were not different among the models (p > 0.05).
Figure 8
Figure 8
Time course of changes in corrected (CDVA) and uncorrected distance visual acuity (UDVA). Both UDVA (p < 0.001) and CDVA (p < 0.001) showed significant changes after surgery. UDVA at 5 years (*p = 0.004) and 8 years (**p < 0.001) postoperatively was significantly worse than UDVA at 1 month postoperatively. CDVA at 5 years (**p < 0.001) and 8 years **(p < 0.001) after surgery was significantly worse than CDVA at 1 month postoperatively. logMAR logarithm of minimum angle of resolution.
Figure 9
Figure 9
Time course of changes in uncorrected (UDVA) and corrected distance visual acuity (CDVA) in eyes with preoperative with-the-rule astigmatism. There were no significant changes in UDVA (p = 0.064) and CDVA (p = 0.109) after surgery. logMAR logarithm of minimum angle of resolution.
Figure 10
Figure 10
Time course of changes in uncorrected (UDVA) and corrected distance visual acuity (CDVA) in eyes with preoperative against-the-rule astigmatism. UDVA (p < 0.001) and CDVA (p < 0.001) showed a significant decline after surgery. UDVA at 5 years (*p = 0.009) and 8 years (**p < 0.001) postoperatively was significantly worse than UDVA at 1 month postoperatively. CDVA at 5 years (†p = 0.003) and 8 years (‡p = 0.002) after surgery was significantly worse than CDVA at 1 month postoperatively. logMAR logarithm of minimum angle of resolution.
Figure 11
Figure 11
Time course of changes in uncorrected (UDVA) and corrected distance visual acuity (CDVA) in eyes with preoperative oblique astigmatism. There were no significant changes in UDVA (p = 0.074) and CDVA (p = 0.113). logMAR logarithm of minimum angle of resolution.
Figure 12
Figure 12
Time course of changes in uncorrected distance visual acuity (UDVA) by the model of toric IOLs. UDVA was not different among the models (p > 0.05). logMAR logarithm of minimum angle of resolution.
Figure 13
Figure 13
Time course of changes in corrected distance visual acuity (CDVA) by the model of toric IOLs. UDVA was not different among the models (p > 0.05). logMAR logarithm of minimum angle of resolution.
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