Efficacy of the Image-Guided Alignment System for a Four-Haptic Hydrophobic Monofocal Toric Intraocular Lens

Objective: To compare the difference in performance between the image-guided alignment system and the manual-marking method in the four-haptic hydrophobic monofocal toric intraocular lens (IOL). Methods: Medical records of patients who underwent cataract surgery with a four-haptic hydrophobic monofocal toric IOL implantation between May 2020 and April 2021 and with 3-month visit data available were investigated. Toric IOL misalignment, residual astigmatism, and mean prediction errors between the two groups were compared. Results: This study included 49 eyes of 44 patients (women: 68%; mean age: 67.2±7.0 [range: 47–82] years). Twenty-nine eyes of 26 patients were treated with toric IOL implantation using the image-guided system and 20 eyes of 18 patients were treated using the manual-marking method. No statistical differences were observed regarding the baseline characteristics of the two groups. Three months after the surgery, the misalignment of the toric IOL was significantly lower in the image-guided group (2.18°±0.65°, range: 1.26°–3.95°) than in the manual; marking group (4.72°±0.74°, range: 3.44°–6.21°; P<0.001). Conclusion: In comparison to the manual-marking method, the image-guided system reduced the misalignment of a four-haptic hydrophobic monofocal toric IOL.