Toric intraocular lenses versus paired opposite corneal incisions in correction of low-grade astigmatism after phacoemulsification: a comparative study

Purpose To compare toric intraocular lens (IOL) implantation versus monofocal (Eyhance) IOL with paired corneal incisions for correction of low-grade astigmatism after phacoemulsification. Patients and methods A retrospective comparative study included 30 patients with low-grade astigmatism (−0.75 to −1.50 D) who underwent phacoemulsification: group 1 underwent toric IOL implantation (TECNIS toric) and group 2 underwent enhanced monofocal IOL (TECNIS Eyhance) with paired corneal incision along steep corneal meridian. Best-corrected visual acuity, astigmatism power, and axis were assessed preoperatively and 3 months postoperatively. Vector analysis of astigmatism was done using the Alpins method. Results The mean postoperative residual astigmatism was significantly lower in group 1 versus group 2 (−0.357±0.128 and −0.538±0.225 D, respectively; P=0.015). A significantly higher decrease in astigmatism was noted in group 1 (−0.93±0.18 and −0.38±0.69 D, respectively; P=0.006), with no significant difference in postoperative visual acuity. Paired comparison revealed significant decrease in astigmatism (P<0.0001 in group 1 and 0.04 in group 2) and improvement in uncorrected visual acuity (P<0.0001 for both groups). A significantly higher percentage of success was noted in group 1 (P=0.017), with a higher difference vector in group 2 (P=0.008). Conclusion Our results suggest that both toric IOL and paired corneal incision are efficient methods for postoperative astigmatism correction and achieving postoperative spectacle independence in patients with low-grade astigmatism. Toric IOL is superior in reducing postoperative astigmatism, reflecting more consistent results. The recommendation of IOL type and astigmatism correction should be tailored according to the patient’s requirements, especially with the expanded need for good intermediate vision for everyday tasks that may benefit from enhanced IOLs.