An easy and practical method for toric intraocular lens implantation: marking corneal astigmatic axis at slit-lamp

The objective of this study was to present a practical method of marking the corneal astigmatic axis for the patient sitting at the slit-lamp before toric intraocular lens (IOL) implantation. Eighteen eyes of 18 patients, who underwent uncomplicated phacoemulsification, with an implantation of Acrysof toric IOL were included. We marked the astigmatic axis while the patient sitting at the slit-lamp before surgery. The patient was asked to look at a distant target at head height with the fellow eye. Using the rotator switch, the slit light of the slit-lamp was just turned on to the steep astigmatic meridian in the orthograde position. Then, two tips of the astigmatic meridian were marked with a marking pen, where the slit light crossed at the limbus 180° away. Preoperative corneal and postoperative refractive astigmatism values were compared. Uncorrected and corrected postoperative visual acuities (UDVA and BCVA) and IOL rotations at early and late periods were noted. The mean age and mean follow-up were 63.6 ± 14.6 years and 9.4 ± 5.3 months (range 3–16 months), respectively. Mean postoperative UDVA and BCVA at Snellen chart were 0.62 ± 0.21 and 0.82 ± 0.13, respectively. Mean preoperative keratometric and mean postoperative refractive astigmatism values were 2.48 ± 0.87 D and 0.66 ± 0.48 D, respectively. Reduction of astigmatism was significant (p < 0.01). The mean rotation at 1 week and that at last follow-up were 2.1° ± 3.1° and 2.3° ± 3.0°, respectively. Marking corneal astigmatic axis at slit-lamp is a simple and effective method in toric intraocular lens implantation. Surgeon does not need additional instrument except a slit-lamp and a marking pen, and can complete the marking task in just one setting.