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J Cataract Refract Surg. 2011 Aug;37(8):1411-8. doi: 10.1016/j.jcrs.2011.02.028. Epub 2011 Jun 23.

Results of higher power toric intraocular lens implantation.

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Augen- und Laserklinik, Castrop-Rauxel, Germany.



To evaluate the efficacy, predictability, and safety of coaxial microincision phacoemulsification and toric intraocular lens (IOL) implantation in eyes with high corneal astigmatism.


Two eye clinics in Germany.


Case series.


Routine cataract extraction using 2.2 mm coaxial phaco equipment and Acrysof toric IOL (3.00 to 6.00 diopters [D] cylinder) implantation were performed. Examinations included optical biometry, Haigis IOL calculation, topography, and objective and subjective refractions. Retroillumination images were used to evaluate IOL alignment. Postoperative examinations were scheduled at 1 week and 3 months.


The study enrolled 40 eyes (30 patients). The mean preoperative keratometric cylinder was 3.55 ± 0.73 D (range 2.64 to 5.39 D) and the mean 3-month postoperative subjective cylinder, 0.67 ± 0.32 D. The mean logMAR uncorrected distance visual acuity improved from 0.93 to 0.20 and the mean logMAR CDVA, from 0.41 to 0.09. The mean prediction error (spherical equivalent) was +0.14 ± 0.44 D. The mean IOL rotation between 1 week and 3 months was 0.23 ± 1.9 degrees clockwise. The mean surgically induced astigmatism was 0.08 ± 0.41 D. The alignment error was below 10 degrees in 97.5% of cases. The mean vector change in refractive cylinder between 1 week and 3 months was 0.31 ± 0.19 D. The Alpins correction index was +1.01, indicating a slight tendency toward overcorrection.


Coaxial microincision phacoemulsification with toric IOL safely and predictably reduced high corneal astigmatism and improved surgical outcomes. Thorough planning and precise execution are necessary.

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