Comparative Meta-Analysis of Toric Intraocular Lens Alignment Accuracy in Cataract Patients: Image-guided System Versus Manual Marking

J Cataract Refract Surg. 2019 Sep;45(9):1340-1345. doi: 10.1016/j.jcrs.2019.03.030.


This meta-analysis studied toric intraocular lens (IOL) alignment accuracy using image-guided and manual marking methods by comparing the axis misalignment of toric IOLs, percentage of eyes with toric IOL axis misalignment within ±5 degrees, postoperative astigmatism, difference vector, and postoperative uncorrected distance visual acuity. The methodological quality was assessed using the modified Quality Assessment of Diagnostic Accuracy Studies-2 tool. Continuous variables were analyzed using weighted mean differences, and dichotomous variables were compared using the odds ratio. Five studies comprising a total of 257 eyes were analyzed. For heterogeneity, neither sensitivity analysis nor the Egger test detected statistical findings. The image-guided marking group had smaller toric IOL axis misalignment (P < .00001), less postoperative astigmatism (P = .003), and a smaller difference vector (P < .00001) than the manual marking group. The overall evidence from the studies indicates that image-guided marking is better than manual marking, resulting in less axis misalignment, a smaller difference vector, and less postoperative astigmatism.

Publication types

  • Review
  • Research Support, Non-U.S. Gov't