title: Outcome of adjustment for posterior corneal curvature in toric intraocular lens calculation and selection.
abstract: To evaluate the accuracy of the cylinder power choice and the astigmatic refractive outcome for toric intraocular lenses (IOLs), the cylinder power of which was calculated using the Goggin nomogram that allows for the likely effect of posterior corneal astigmatism.
  
  
  
  The Queen Elizabeth Hospital, Adelaide, Australia.
  
  
  
  Observational case series.
  
  
  
  The absolute value of the prediction error of the toric IOL cylinder power effect in consecutive eyes with preoperative anterior keratometric cylinder values of 1.0 diopter (D) or more was compared with the absolute value of the prediction error in a historical control group. The anteriorly measured keratometric cylinder values were altered by 2 coefficients of adjustment, one for with-the-rule eyes and one for against-the-rule eyes, before calculation of the IOL cylinder power to be implanted. In the controls, unadjusted keratometric cylinder values were used.
  
  
  
  The case-series group comprised 31 eyes (29 patients) and the control group, 65 eyes. The absolute error in prediction of the toric IOL cylinder power effect was reduced from a median of 0.45 D (95% confidence interval [CI], 0.33-0.58) in the controls to a median of 0.23 D (95% CI, 0.13-0.35) in the adjusted eyes (P = .004).
  
  
  
  Adjustment of toric IOL cylinder power by application of a coefficient of adjustment to anteriorly measured keratometric cylinder values based on the keratometric rule of the eye led to a clinically and statistically significant improvement in refractive astigmatic outcome.
  
  
  
  No author has a financial or proprietary interest in any material or method mentioned.
authors.affiliation: From the South Australian Institute of Ophthalmology (Goggin, van Zyl, Caputo), the University of Adelaide (Goggin, van Zyl, Caputo), The Queen Elizabeth Hospital (Goggin, van Zyl, Caputo), the Sansom Institute of Health Service Research (Esterman), University of South Australia, Adelaide, and the Australian Institute for Health and Medical Research (Esterman), James Cook University, Smithfield, Australia. Electronic address: michael.goggin@sa.gov.au.
authors.forename: Michael
authors.initials: M
authors.lastname: Goggin
authors.affiliation: From the South Australian Institute of Ophthalmology (Goggin, van Zyl, Caputo), the University of Adelaide (Goggin, van Zyl, Caputo), The Queen Elizabeth Hospital (Goggin, van Zyl, Caputo), the Sansom Institute of Health Service Research (Esterman), University of South Australia, Adelaide, and the Australian Institute for Health and Medical Research (Esterman), James Cook University, Smithfield, Australia.
authors.forename: Lourens
authors.initials: L
authors.lastname: van Zyl
authors.affiliation: From the South Australian Institute of Ophthalmology (Goggin, van Zyl, Caputo), the University of Adelaide (Goggin, van Zyl, Caputo), The Queen Elizabeth Hospital (Goggin, van Zyl, Caputo), the Sansom Institute of Health Service Research (Esterman), University of South Australia, Adelaide, and the Australian Institute for Health and Medical Research (Esterman), James Cook University, Smithfield, Australia.
authors.forename: Silvestro
authors.initials: S
authors.lastname: Caputo
authors.affiliation: From the South Australian Institute of Ophthalmology (Goggin, van Zyl, Caputo), the University of Adelaide (Goggin, van Zyl, Caputo), The Queen Elizabeth Hospital (Goggin, van Zyl, Caputo), the Sansom Institute of Health Service Research (Esterman), University of South Australia, Adelaide, and the Australian Institute for Health and Medical Research (Esterman), James Cook University, Smithfield, Australia.
authors.forename: Adrian
authors.initials: A
authors.lastname: Esterman
mesh_terms: D001251:Astigmatism / Q000628:therapy*; D001315:Australia; D001699:Biometry; D016022:Case-Control Studies; D003315:Cornea / Q000033:anatomy & histology; D006801:Humans; D019654:Lens Implantation, Intraocular; D007910:Lenses, Intraocular; D018918:Phacoemulsification; D012029:Refraction, Ocular; D012189:Retrospective Studies