Toric intraocular lens implantation in comparison to Femtoassisted astigmatic keratotomy to correct astigmatism during phacoemulsification cataract surgeries

Background: for the comparison of the visual outcome including visual acuity and target refraction, surgical operative difficulties, and the results of the toric intraocular lens (IOL) implantation versus Femto-assisted astigmatic keratotomy (AK) in the correction of astigmatism during phacoemulsification. Subjects & Methods: A randomized comparative interventional study was demonstrated on cases with cataract surgical operations who were engaged from Alex Eye Center outpatient clinic, From May 2017 to January 2019. Forty-four eyes were involved in the current work; all of them had visually significant cataracts and mild manifest astigmatism (1.25 to 3.00 diopters). Twenty-two eyes had treated by Femto-assisted AK with the usage of a planned depth, optical zone, and length of the keratotomy valuated with Bascom palmer nomogram and adapted by Donnenfield nomogram and followed by implanting of an intraocular lens. A further 22 eyes were treated by Clear corneal 2.4 mm phacoemulsification with toric IOL implantation. All cases were followed-up for 6-months. Results: UCVA has exhibited a better outcome with a statistically significant change in the toric IOL group (mean of 0.73) in comparison to the AK group (mean of 0.57) at the end of the follow-up period. Also, BSCVA gives a better outcome in the toric IOL group (mean of 0.9) in comparison to the AK group (mean of 0.8). The difference has a statistical significance. Vector analysis concluded that: no significant change was existing in targetinduced astigmatism (TIA) in the studied groups. The surgically induced astigmatism (SIA) was high in the toric group in comparison to the AK group with a mean of 1.23 in the AK group and 2.17 in the toric group and a P-value of 0.0001. The difference vector (DV) mean was 1.16 in the AK group and 0.92 in the toric group, P-value of 0.05 (no statistical significance), and the correction index (CI) means in the AK group and the toric IOL group were 0.75±0.53, 0.81±0.35 respectively. Conclusion: A comparison of astigmatic keratotomy and the toric IOLs in the treatment of corneal astigmatism during phacoemulsification showed evidence that both techniques are efficient, predictable, and safe in reducing corneal astigmatism with an observed superiority of the toric IOLs this superiority of the toric IOL was observed in the better UCVA, BCVA, less residual astigmatism, and better indices of vector analysis.