Toric intraocular lens versus monofocal intraocular lens implantation and photorefractive keratectomy: a randomized controlled trial.

Purpose: To compare the outcomes of phacoemulsification with toric intraocular lens implantation vs phacoemulsification with monofocal intraocular lens implantation followed by photorefractive keratectomy (PRK) for correction of pre-existing astigmatism.
Design: Randomized controlled trial, 6-month study.
Methods: setting: Institutional.
Study Population: Sixty eyes of 52 patients with age-related senile cataract and regular corneal astigmatism ranging from 1.50 to 3.00 diopters, enrolled and randomly allocated in 2 groups based on computer-generated random number table.
Intervention: Group 1 patients underwent phacoemulsification with toric intraocular lens (IOL) implantation and Group 2 patients underwent phacoemulsification with monofocal IOL implantation followed by PRK 3 months later.
Main Outcome Measures: The main outcome measures were uncorrected distance visual acuity (UDVA), corrected distance visual acuity (CDVA), residual cylinder, contrast sensitivity, glare acuity, pain score, and higher-order aberrations.
Results: At 6 months 53.3% of eyes in the toric IOL and 60% eyes in the monofocal IOL with PRK group attained UDVA of 20/20. Median residual refractive cylinder value was higher in the toric IOL group (toric IOL = -0.5, monofocal IOL with PRK = 0; P = .02). Mean root mean square value of total aberrations (5 mm pupil) was higher in monofocal IOL with PRK eyes (toric IOL= 1.02 ± 0.44, monofocal IOL with PRK = 1.28 ± 0.5; P = .04). Mean contrast sensitivity values were comparable. Mean toric IOL rotation was 1.3 ± 2.1 degrees. Mean glare acuity was better in toric IOL eyes (toric IOL = 0.46 ± 0.16, monofocal IOL with PRK = 0.73 ± 0.12; P < .001). Median postoperative pain scores were higher in monofocal IOL with PRK eyes.
Conclusion: PRK yields lesser residual cylinder compared to toric IOL. However, it causes greater postoperative pain and corneal aberrations, and poor glare acuity.
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