Rotational Stability of Three Toric Intraocular Lens Platforms After Cataract Surgery: A Prospective Multicenter Randomized Trial.

PURPOSE: To compare the postoperative rotational stability of three toric intraocular lens (IOL) platforms and identify platform-specific biometric factors associated with rotation.

SETTING

Three eye centers in China.

DESIGN

Prospective multicenter randomized controlled trial.

METHODS

A total of 256 eyes of 172 cataract patients with regular corneal astigmatism that completed 3 months of follow-up after phacoemulsification with implantation of TECNIS Toric II, Clareon Toric, or AT TORBI 709M were included. Participants were randomly assigned to 1 of the 3 toric IOL platforms. Baseline rotational alignment was defined at the end of surgery and compared with retroillumination images obtained at 1 day, 3 days, 1 week, 2 weeks, 1 month, and 3 months postoperatively.

RESULTS

Absolute rotation changed most prominently within the first week and then progressively stabilized. Rotational stability was reached earlier in the ZCU and CNW0T groups, which plateaued at 1 week, whereas the 709 approached stability between 2 weeks and 1 month. Throughout follow-up, the 709 showed greater rotation than the CNW0T, whereas the ZCU demonstrated the least rotation. Significant rotation of ≥10° occurred in 1.2%, 2.4%, and 12.2% of eyes, respectively. White-to-white distance was associated with greater rotation in the CNW0T and 709 groups, lens thickness was additionally associated with greater rotation in the 709 group, and no biometric factor reached significance in the ZCU group.

CONCLUSIONS

Hydrophobic C-loop toric IOLs showed better early rotational stability than the hydrophilic plate-haptic toric IOL. Biometric correlates of rotation differed across platforms, supporting individualized toric IOL selection and postoperative monitoring.