title: Toric intraocular lens versus monofocal intraocular lens implantation and photorefractive keratectomy: a randomized controlled trial.
abstract: OBJECTIVE
  To compare the outcomes of phacoemulsification with toric intraocular lens implantation vs phacoemulsification with monofocal intraocular lens implantation followed by photorefractive keratectomy (PRK) for correction of pre-existing astigmatism.
  
  
  METHODS
  Randomized controlled trial, 6-month study.
  
  
  METHODS
  setting: Institutional.
  
  
  METHODS
  Sixty eyes of 52 patients with age-related senile cataract and regular corneal astigmatism ranging from 1.50 to 3.00 diopters, enrolled and randomly allocated in 2 groups based on computer-generated random number table.
  
  
  METHODS
  Group 1 patients underwent phacoemulsification with toric intraocular lens (IOL) implantation and Group 2 patients underwent phacoemulsification with monofocal IOL implantation followed by PRK 3 months later.
  
  
  METHODS
  The main outcome measures were uncorrected distance visual acuity (UDVA), corrected distance visual acuity (CDVA), residual cylinder, contrast sensitivity, glare acuity, pain score, and higher-order aberrations.
  
  
  RESULTS
  At 6 months 53.3% of eyes in the toric IOL and 60% eyes in the monofocal IOL with PRK group attained UDVA of 20/20. Median residual refractive cylinder value was higher in the toric IOL group (toric IOL = -0.5, monofocal IOL with PRK = 0; P = .02). Mean root mean square value of total aberrations (5 mm pupil) was higher in monofocal IOL with PRK eyes (toric IOL= 1.02 ± 0.44, monofocal IOL with PRK = 1.28 ± 0.5; P = .04). Mean contrast sensitivity values were comparable. Mean toric IOL rotation was 1.3 ± 2.1 degrees. Mean glare acuity was better in toric IOL eyes (toric IOL = 0.46 ± 0.16, monofocal IOL with PRK = 0.73 ± 0.12; P < .001). Median postoperative pain scores were higher in monofocal IOL with PRK eyes.
  
  
  CONCLUSIONS
  PRK yields lesser residual cylinder compared to toric IOL. However, it causes greater postoperative pain and corneal aberrations, and poor glare acuity.
authors.affiliation: Rajendra Prasad Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, New Delhi, India.
authors.forename: Ritu
authors.initials: R
authors.lastname: Nagpal
authors.affiliation: Rajendra Prasad Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, New Delhi, India. Electronic address: namrata.sharma@gmail.com.
authors.forename: Namrata
authors.initials: N
authors.lastname: Sharma
authors.affiliation: Iladevi Cataract & IOL Research Centre, Ahmedabad, India.
authors.forename: Viraj
authors.initials: V
authors.lastname: Vasavada
authors.affiliation: Rajendra Prasad Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, New Delhi, India.
authors.forename: Prafulla K
authors.initials: PK
authors.lastname: Maharana
authors.affiliation: Rajendra Prasad Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, New Delhi, India.
authors.forename: Jeewan S
authors.initials: JS
authors.lastname: Titiyal
authors.affiliation: Rajendra Prasad Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, New Delhi, India.
authors.forename: Rajesh
authors.initials: R
authors.lastname: Sinha
authors.affiliation: Department of Statistics, All India Institute of Medical Sciences, New Delhi, India.
authors.forename: Ashish D
authors.initials: AD
authors.lastname: Upadhyay
authors.affiliation: Rajendra Prasad Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, New Delhi, India.
authors.forename: Rasik B
authors.initials: RB
authors.lastname: Vajpayee
mesh_terms: D000368:Aged; D001251:Astigmatism / Q000150:complications / Q000601:surgery*; D002386:Cataract / Q000150:complications / Q000628:therapy; D015350:Contrast Sensitivity / Q000502:physiology; D004311:Double-Blind Method; D058447:Eye Pain / Q000175:diagnosis; D005260:Female; D005500:Follow-Up Studies; D019466:Glare; D006801:Humans; D019654:Lens Implantation, Intraocular; D007910:Lenses, Intraocular; D008297:Male; D008875:Middle Aged; D018918:Phacoemulsification; D018903:Photorefractive Keratectomy; D011183:Postoperative Complications; D011446:Prospective Studies; D011474:Prosthesis Design; D014792:Visual Acuity / Q000502:physiology