Clinical Outcomes and In Vivo Wavefront Analysis of a Toric Transcleral Plug-Fixated IOL Using a Pyramidal Sensor Aberrometer

Purpose: – To evaluate the visual, refractive, and aberrometric outcomes of a toric (T) FIL–SSF intraocular lens (IOL) implanted in aphakic eyes lacking capsular support.Setting: – Ospedale Piero Palagi and Azienda Ospedaliera Universitaria Careggi, Florence, Italy.Design: – Multicenter prospective observational case series.Methods: – Aphakic eyes with regular corneal astigmatism >1 D underwent sutureless transscleral fixation of a T FIL–SSF IOL. Preoperative assessment included UDVA, CDVA, manifest refraction, corneal tomography, and biometry. Postoperative visits occurred at 1 day, 7 days, and 1, 3, and 6 months. At 6 months, vector astigmatism analysis, wavefront aberrometry, and IOL alignment were performed.Results: – Fifteen eyes from 12 patients completed the 6-month follow-up. Mean UDVA improved from 0.96 ± 0.25 to 0.19 ± 0.10 logMAR and CDVA from 0.41 ± 0.32 to 0.04 ± 0.05 logMAR (both P <.001). Mean postoperative spherical equivalent prediction error was –0.12 ± 0.54 D. Mean absolute corneal astigmatism decreased from 2.15 ± 0.54 D to a mean refractive astigmatism of 0.73 ± 0.48 D. Wavefront aberrometry showed total astigmatism of 0.36 ± 0.28 µm, with mean total higher order aberrations (HOAs) of 0.24 ± 0.08 µm. Mean IOL misalignment was 3.33 ± 3.42°, significantly correlated with residual refractive astigmatism (ρ = 0.71 P <.01).Conclusions: – T FIL–SSF IOL implantation provided substantial improvements in visual acuity, predictable refractive outcomes, and significant cylinder reduction in aphakic eyes with corneal astigmatism lacking capsular support