Astigmatic Results of a Diffractive Trifocal Toric IOL Following Intraoperative Aberrometry Guidance

Purpose: To determine if intraoperative aberrometry (IA) improves astigmatic outcomes for trifocal toric IOL (TTI) cases. Patients and Methods: This was a retrospective study examining 137 eyes that underwent cataract extraction and TTI implantation using femtosecond laser, digital registration, and IA. Final cylinder power and axis of placement were determined by IA. Monocular uncorrected distance visual acuity (UDVA), uncorrected intermediate visual acuity (UIVA), uncorrected near visual acuity (UNVA), and refractive data were collected at 3 months. Postoperative residual astigmatism (PRA) determined by manifest refraction was compared to back-calculated residual astigmatism (BRA) using the cylinder power calculated preoperatively. Results: Postoperatively, 97.8% of eyes had IA PRA <= 0.50D and 80.3% had BRA <= 0.50 D, a difference of 17.5%. Mean PRA for IA was 0.07 D +/- 0.19 (range 0.00-1.00 D) compared to BRA 0.31 D +/- 0.33 (range 0.00-1.34 D) (P < 0.001). Cylinder power was changed in 50.4% of cases based upon IA. Postoperative mean UDVA (LogMAR) was 0.04 +/- 0.09 (range -0.12-0.30 logMAR), and 65% of eyes were <= 0.0, 85% <= 0.1, and 99% <= 0.18. Conclusion: The proportion of eyes with PRA <= 0.50 D and mean PRA was significantly lower using IA versus the preoperative planned cylinder power.