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Indian J Ophthalmol. 2020 Apr;68(4):583-586. doi: 10.4103/ijo.IJO_1253_19.

Evaluation of Scheimpflug imaging system as an added tool in improving the accuracy of reference marking (as compared to the slit lamp marking system) for toric intraocular lens implantation.

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Amber Eye Care and Micro Surgery Centre, Thane, Maharashtra, India.



To assess the role of Scheimpflug imaging in improving the accuracy of reference marking for toric IOL implantation.


In this prospective, randomized, clinical trial all patients with cataract and pre-existing significant regular corneal astigmatism, who required implantation of a toric IOL were included in the study, and patients with any ocular pathology or abnormality were excluded. Patients were divided into two groups: For one group of patients, Group I (GI), reference marking was finalized using slit lamp only, and for the second group, Group II (GII), after slit lamp marking, the reference marks were checked using Goniometer of Scheimpflug imaging. The primary outcome was to determine the axis of toric intraocular lens (IOL) postoperatively (within 1 hour) and compare it with the desired axis of placement.


We found a statistically significant difference in the two groups (P < 0.001) suggesting Group II (4 step technique) is better than Group I (3 step technique).


Scheimpflug imaging, an extra step preoperatively, is an effective measure to reduce errors in reference marking and thereby improving the refractive outcome of toric intraocular lens.


Reference marking; Scheimpflug imaging; slit lamp biomicroscope; toric IOL

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