Refractive Outcomes of Toric and Non-Toric IOLs in Post-Radial Keratotomy Eyes: A Comparative Study

Abstract Purpose To compare refractive outcomes in post-radial keratotomy (RK) eyes undergoing cataract surgery with toric versus non-toric intraocular lenses (IOLs), using clinical and vector-based astigmatism analysis. Methods Consecutive post-RK eyes undergoing uneventful phacoemulsification were included. Toric IOLs were offered to eyes with clear corneas and repeatable keratometry; acceptance was based on patient preference and affordability. The Barrett True-K Toric calculator was used. All surgeries were performed with digital marking and low-pressure phaco settings. Intraoperative wound leaks were noted and sutured if required . Results Of 24 eyes included, 10 received toric IOLs and 14 non-toric. The non-toric group had significantly longer axial lengths (30.01±3.5mm vs. 26.31±2.4 mm, p=0.02) and worse baseline BCVA (0.83 ± 0.5 vs. 0.41 ± 0.5 logMAR, p=0.01). At 1 month, cylindrical neutrality was achieved in 70% of toric eyes versus 20% of non-toric eyes (p < 0.001). Among eyes with residual cylinder, the mean was –0.35 ± 0.6D in the toric group versus –1.43 ± 1.3 D in the non-toric group (p=0.03). Vector analysis corroborated superior astigmatic correction in the toric group. Wound leaks occurred in 11 eyes (46%) overall, predominantly in 16-cut RK eyes and those with longer axial lengths. Conclusion Toric IOLs significantly improve refractive outcomes in post-RK eyes. While wound leaks remain a major surgical concern, particularly in 16-cut RK eyes, careful planning, appropriate IOL selection, and intraoperative vigilance can lead to safe surgery and excellent visual outcomes.