title: Treatment of astigmatism during phacoemulsification.
abstract: OBJECTIVE
  To compare the effectiveness of limbal relaxing incisions (LRI) with that of toric intraocular lens (IOL) implantation for the treatment of astigmatism during phacoemulsification using nonvectorial (predictability, safety, and efficacy) and vectorial analyses.
  
  
  METHODS
  This longitudinal observational case series assessed 62 eyes of 31 consecutive cataract patients with preoperative corneal astigmatism of 0.75-2.50 diopters (D) in both eyes. Patients were randomly assigned to 2 groups: a toric IOL group, which received toric IOLs in both eyes, and an LRI group, which received spherical IOLs associated with LRI placement in both eyes. All patients were evaluated at 1, 3, and 6 months after surgery, when refractive astigmatism analysis was performed using both nonvectorial and Alpins vectorial methods. Outcomes were assessed within each group and compared between groups.
  
  
  RESULTS
  The proportion of eyes within ±0.50 D of the intended correction at 3 and 6 months after surgery was 75% and 71.88%, respectively, in the LRI group and 40% and 66.67%, respectively, in the toric IOL group. In the remaining period, the proportion was greater in the toric IOL group. The safety index showed no difference at any time point. The efficacy index at 1 and 3 months after surgery was significantly higher in the toric IOL group (0.43 and 0.44, respectively) than in the LRI group (0.31 and 0.36, respectively). At 6 months after surgery, the status of eyes in the LRI group was as follows: 53.13% were undercorrected, 43.74% achieved the intended correction, and 3.13% were overcorrected. In the toric IOL group, 16.76% eyes were undercorrected, 76.67% achieved the intended correction, and 6.67% were overcorrected. The success rates for astigmatic surgery, astigmatism reduction at the intended axis, and astigmatism corrected were 43%, 62%, and 64%, respectively, in the LRI group and 57%, 81%, and 94%, respectively, in the toric IOL group.
  
  
  CONCLUSIONS
  Our results suggest that the use of toric IOLs may be advantageous over the use of LRIs for the treatment of astigmatism during phacoemulsification. Although such advantages seem subtle in nonvectorial analyses, they are highlighted in vectorial analyses.
authors: Universidade Federal de Minas Gerais, Belo Horizonte, MG, Brazil.
authors: Giuliano Oliveira
authors: GO
authors: Freitas
authors: Universidade Federal de Minas Gerais, Belo Horizonte, MG, Brazil.
authors: Joel Edmur
authors: JE
authors: Boteon
authors: Cataract Surgery Department, ISO - Olhos - Instituto de Saúde Ocular, Uberlândia, MG, Brazil.
authors: Mario José
authors: MJ
authors: Carvalho
authors: Universidade Federal de Uberlândia, Uberlândia, MG, Brazil.
authors: Rogerio Melo Costa
authors: RM
authors: Pinto
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D001251:Astigmatism / Q000150:complications / Q000601:surgery; D002386:Cataract / Q000150:complications; D005500:Follow-Up Studies; D019654:Lens Implantation, Intraocular / Q000009:adverse effects / Q000379:methods; D008137:Longitudinal Studies; D018918:Phacoemulsification / Q000379:methods; D016896:Treatment Outcome; D014792:Visual Acuity