Comparison between toric and spherical phakic intraocular lenses combined with astigmatic keratotomy for high myopic astigmatism

Background: To compare the outcomes of a toric phakic intraocular lens (PIOL) and a spherical PIOL combined with astigmatic keratotomy (AK) for the correction of high myopic astigmatism. Methods: This study enrolled patients with high myopic astigmatism, including 30 eyes (22 patients) that received a toric PIOL implantation (TICL group), and 32 eyes (24 patients) that received combined AK and a spherical PIOL implantation (AK+ ICL group). The outcomes were compared between the two groups before surgery, and at the following time points after surgery: 1 week, 1, 3, 6 months, and 1, 2 years. Results: Preoperatively, the mean manifest spherical equivalent (SE) was -14.14 +/- 2.12 D in the TICL group and -14.83 +/- 2.79 D in the AK + ICL group (P = 0.28), and the mean manifest refractive cylinder, -2.87 +/- 1.09 D and -2. 58 +/- 0.85 D, respectively (P = 0.28). Two years postoperatively, the mean safety index was 1.53 +/- 0.55 in the TICL group and 1.60 +/- 0.70 in the AK + ICL group (P = 1.00), and the mean efficacy index, 1.18 +/- 0.45 and 1.38 +/- 0.52, respectively (P = 0.86). The mean manifest refractive cylinder correction was 1.94 +/- 1.07 D in the TICL group and 1. 39 +/- 0.71 D in the AK + ICL group (P = 0.02). The mean changes in SE and refractive cylinder from 1 week to 2 years were less than 0.50 D in both groups. Conclusions: Both TICL implantation and AK + ICL implantation are a good alternative for correction of astigmatism in addition to high myopia. TICL implantation has better predictability in correction of high myopic astigmatism.