Toric intraocular lenses are implanted specifically to correct corneal astigmatism during cataract surgery. For the lens to function correctly, it must remain precisely aligned with the steep axis of the cornea. Even small deviations from the intended axis reduce the effectiveness of the correction, and rotation beyond approximately ten degrees can negate it almost entirely. ¹
In most cases, toric lenses remain stable within the capsular bag after surgery. However, in eyes where the capsular bag is larger than average, or where postoperative inflammation alters the relationship between the lens and the capsule, some degree of rotation can occur. ² Patients may notice the return of astigmatic blur, vision that is slightly smeared or doubled in one meridian, that was not present immediately after surgery.
Assessment involves measuring the current lens axis using slit-lamp examination or corneal topography and comparing it to the intended alignment recorded at the time of surgery. If the rotation is significant, surgical repositioning under topical anaesthesia is a straightforward procedure that restores the intended correction. ¹
Smaller degrees of residual astigmatism following toric lens rotation are increasingly managed with laser enhancement rather than further intraocular surgery, avoiding a return to theatre.
References
1. Chang DF. Toric intraocular lens rotational stability. Journal of Cataract and Refractive Surgery. 2017;43(1):29–37.
2. Visser N, Bauer NJ, Nuijts RM. Toric intraocular lenses: historical overview, patient selection, IOL calculation, surgical techniques, clinical outcomes, and complications. Journal of Cataract and Refractive Surgery. 2013;39(4):624–637.
3. Oshika T, Inamura M, Inoue Y, et al. Formal evaluation of the reproducibility and accuracy of a new toric IOL calculation method with the new HICSOAP formula. Journal of Refractive Surgery. 2019;35(2):94–100.
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