Phacoemulsification with Toric Intraocular Lens Implantation for Cataract and Corneal Astigmatism

Toric intraocular lenses allow cataract removal and correction of corneal astigmatism within the same procedure. Their effectiveness depends on the regularity and stability of the cornea, measurement quality, calculation methods, surgical alignment and postoperative rotational stability. Evidence was assessed from comparative studies of toric implantation and corneal incisions, posterior corneal astigmatism, image-guided alignment, lens design and selected complex eyes. The evidence supports clinically useful reduction of residual astigmatism in appropriately selected cataract populations, while emphasizing that refractive accuracy is a property of the entire measurement and surgical pathway. Multifocal and extended optical designs introduce additional considerations concerning visual quality and patient expectations. Studies in keratoconus, post-keratoplasty eyes or phakic lens implantation cannot be generalized directly to routine pseudophakic cataract surgery. Consistent reporting of residual cylinder, axis, uncorrected and corrected visual acuity, rotation and patient-reported function is necessary for meaningful comparison.