Long-term Astigmatism Reduction with Toric Intraocular Lenses – A Systematic Review.

Topic: This study aimed to assess the long-term effectiveness of toric intraocular lenses (IOL) in reducing refractive astigmatism at and beyond one year, along with long-term rotational stability and reoperation rates. Clinical relevance: Toric IOLs are widely used to correct corneal astigmatism during cataract surgery. However, most reports are limited to early post-operative outcomes. Methods: We conducted a systematic review of long-term outcomes following toric IOL implantation. We searched Ovid Embase and PubMed using the terms '(toric IOL)' AND '(toric intraocular lens)' AND '(long term)' AND '(outcome)' up to April 11, 2025. Studies reporting outcomes of at least 1 year after implantation in otherwise healthy eyes were included. Eyes with ocular comorbidities other than cataracts were excluded. The primary outcomes were residual refractive astigmatism, IOL rotation, and reoperation rates. The study protocol was registered at PROSPERO (CRD420251154641). Results: Nineteen studies comprising 15 cohorts, 3 case series and 1 case report totalling 1,180 participants and 1,564 eyes were analysed. The mean follow-up period was 29.9 + 23.7 (range 12-96) months. The mean residual cylinder was - 0.65 + 0.39D at one year (p < 0.0001) and -0.80 + 0.54 D (p=0.01) at two years. The mean IOL rotation was 2.27 + 1.40 and 2.82 + 1.73 degrees at one and two years respectively. Twelve IOLs (0.77%) required repositioning. Conclusions: Toric IOL implantation maintains effective astigmatism reduction for up to two years. Longer-term data remained scarce. The majority of toric IOLs exhibited excellent rotational stability and reoperation rate was low.