title: Toric Intraocular Lenses in the Correction of Astigmatism During Cataract Surgery: A Systematic Review and Meta-analysis.
abstract: OBJECTIVE
  We performed a systematic review and meta-analysis to evaluate the benefit and harms associated with implantation of toric intraocular lenses (IOLs) during cataract surgery. Outcomes were postoperative uncorrected distance visual acuity (UCDVA) and distance spectacle independence. Harms were evaluated as surgical complications and residual astigmatism.
  
  
  CONCLUSIONS
  Postoperative astigmatism is an important cause of suboptimal UCDVA and need for distance spectacles. Toric IOLs may correct for preexisting corneal astigmatism at the time of surgery.
  
  
  METHODS
  We performed a systematic literature search in the Embase, PubMed, and CENTRAL databases within the Cochrane Library. We included randomized clinical trials (RCTs) if they compared toric with non-toric IOL implantation (± relaxing incision) in patients with regular corneal astigmatism and age-related cataracts. We assessed the risk of bias using the Cochrane Risk of Bias tool. We assessed the quality of evidence across studies using the GRADE profiler software (available at: www.gradeworkinggroup.org).
  
  
  RESULTS
  We included 13 RCTs with 707 eyes randomized to toric IOLs and 706 eyes randomized to non-toric IOLs; 225 eyes had a relaxing incision. We found high-quality evidence that UCDVA was better in the toric IOL group (logarithm of the minimum angle of resolution [logMAR] mean difference, -0.07; 95% confidence interval [CI], -0.10 to -0.04) and provided greater spectacle independence (risk ratio [RR], 0.51; 95% CI, 0.36-0.71) and moderate quality evidence that toric IOL implantation was not associated with an increased risk of complications (RR, 1.73; 95% CI, 0.60-5.04). Residual astigmatism was lower in the toric IOL group than in the non-toric IOL plus relaxing incision group (mean difference, 0.37 diopter [D]; 95% CI, -0.55 to -0.19).
  
  
  CONCLUSIONS
  We found that toric IOLs provided better UCDVA, greater spectacle independence, and lower amounts of residual astigmatism than non-toric IOLs even when relaxing incisions were used.
authors.affiliation: Department of Ophthalmology, Rigshospitalet - Glostrup, Glostrup, Denmark; National Danish Medicines and Health Authorities, Copenhagen, Denmark. Electronic address: line.kessel@dadlnet.dk.
authors.forename: Line
authors.initials: L
authors.lastname: Kessel
authors.affiliation: Skanderborg Eye Clinic, Skanderborg, Denmark.
authors.forename: Jens
authors.initials: J
authors.lastname: Andresen
authors.affiliation: National Danish Medicines and Health Authorities, Copenhagen, Denmark; The Nordic Cochrane Center, Copenhagen, Denmark.
authors.forename: Britta
authors.initials: B
authors.lastname: Tendal
authors.affiliation: Department of Ophthalmology, Næstved Hospital, Næstved, Denmark.
authors.forename: Ditte
authors.initials: D
authors.lastname: Erngaard
authors.affiliation: Odense Eye Clinic, Odense, Denmark.
authors.forename: Per
authors.initials: P
authors.lastname: Flesner
authors.affiliation: Department of Ophthalmology, Aarhus University Hospital NBG, Aarhus, Denmark.
authors.forename: Jesper
authors.initials: J
authors.lastname: Hjortdal
mesh_terms: D001251:Astigmatism / Q000503:physiopathology / Q000601:surgery*; D006801:Humans; D019654:Lens Implantation, Intraocular; D007910:Lenses, Intraocular; D016017:Odds Ratio; D018918:Phacoemulsification; D011474:Prosthesis Design; D016032:Randomized Controlled Trials as Topic; D012029:Refraction, Ocular / Q000502:physiology; D014792:Visual Acuity / Q000502:physiology