A 55-year-old patient has a toric IOL implanted to correct 3.0 D of pre-existing corneal astigmatism. At 1-month follow-up, residual astigmatism is 2.5 D and the patient sees poorly. Slit-lamp examination shows the lens axis marking at 80° but the intended axis was 110°. What is the intervention?

• A Prescribe spectacles as IOL rotation is not correctable
• B Rotate the toric IOL to the intended axis under topical anaesthesia ✓
• C Laser refractive surgery (LASIK) to address residual astigmatism only
• D Exchange for a spherical IOL and use contact lenses

Explanation

Toric IOL malrotation (30° off-axis in this case) significantly reduces the astigmatic correction — approximately 3% of power is lost per degree of axis error, and at 30°, the toric IOL is nearly ineffective. IOL rotation to the intended axis is the recommended surgical intervention if performed within the first few weeks while the capsule has not fully fibrosed around the lens. The procedure is done under topical anaesthesia through the original wound. Spectacles are unnecessary if the IOL is properly aligned. LASIK can address residual astigmatism but is a secondary option after ensuring the IOL is correctly positioned. IOL exchange for a spherical lens wastes the toric correction capability.

Reference: Khurana Comprehensive Ophthalmology, 7th ed.

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Written and medically reviewed by the StethoPrep medical team.