Correcting astigmatism is at the heart of refractive cataract surgery. Whether implanting monofocal, EDOF, or multifocal IOLs, every cataract surgeon should be proficient with using toric IOLs. This includes the techniques to prevent and manage toric IOL misalignment. This lecture will discuss the best preoperative diagnostics and formulae to determine toric IOL power and axis, intraoperative alignment and aberrometry, and management of postoperative toric IOL misalignment. Incisional keratotomy will be covered as an alternative or adjunct to refractive IOL implantation. Finally, complex astigmatism management will be discussed, including small aperture and light-adjustable IOLs. The lecture will also cover patient counseling. The lecture will present the results of several large studies that compare postoperative rotation rates with different toric IOL platforms. Finally, several cases will be presented to illustrate options for posterior capsule rupture when a toric IOL is planned.
Learning Objectives:
Understand preoperative assessment and planning; how to determine power and axis of toric IOL.
Understand strategies for intraoperative toric IOL alignment and preventing postop rotation
Understand management principles for toric IOL misalignment
