Comparison of Corneal Incision Versus Toric Intraocular Lens Techniques Used in Cataract Surgery

Abstract

Background: Astigmatism frequently complicates cataract surgery, adversely affecting postoperative visual outcomes and quality of life. Despite various techniques available, there remains uncertainty regarding the comparative effectiveness of corneal incision versus toric intraocular lens (IOL) implantation for astigmatism correction, particularly in populations with high disease burden. Objective: This study aimed to compare the effectiveness of corneal incision and toric IOL techniques for reducing residual astigmatism and improving uncorrected visual acuity following cataract surgery, with the expectation that toric IOLs would yield superior refractive outcomes. Methods: In a comparative cross-sectional study conducted at tertiary eye hospitals in Lahore, Pakistan, 368 adults (aged 30–70 years) with pre-existing regular astigmatism (-0.75 to -3.75 D) were consecutively enrolled and allocated to either corneal incision or toric IOL groups. Exclusion criteria included prior ocular surgery and corneal pathology. Preoperative, intraoperative, and postoperative data were collected using a standardized proforma, with outcomes assessed at three follow-up visits. Primary endpoints were residual astigmatism and uncorrected visual acuity, analyzed using ANOVA and Wilcoxon signed-rank tests in SPSS 27. Ethical approval and written informed consent were obtained in accordance with the Declaration of Helsinki. Results: At the third follow-up, the toric IOL group achieved significantly lower mean residual astigmatism (-0.25 ± 0.34 D) compared to the corneal incision group (-0.69 ± 0.44 D; mean difference 0.44 D, 95% CI: 0.33 to 0.55, p < 0.001), and a greater proportion achieved ≤0.50 D (79.9% vs. 33.2%; OR 7.89, 95% CI: 4.80 to 12.97). Uncorrected visual acuity was also superior toric IOLs (mean LogMAR 0.13 vs. 0.21, p < 0.001). Complication rates were low and similar between groups. Conclusion: Toric IOL implantation provides more precise and stable astigmatism correction and better visual outcomes than corneal incision techniques in cataract surgery, supporting its preferential use for moderate to high astigmatism in clinical practice.