Analysis of refractive outcomes and related factors in combined filtering surgery with Toric Lens implantation

Abstract

Purpose

To evaluate refractive outcomes and associated factors in patients undergoing combined filtering glaucoma surgery (trabeculectomy or non-penetrating deep sclerectomy (NPDS)) and cataract extraction with toric intraocular lens implantation.

Design

Prospective consecutive case series.

Methods

This prospective case series included 43 eyes of 32 patients with preoperative corneal astigmatism ≥ 0.75 diopters (D) and moderate-to-severe open-angle glaucoma. Patients underwent trabeculectomy or NPDS and cataract surgery with toric intraocular lens (IOL) implantation. Main outcomes included refractive astigmatism (vector and refractive analysis), spherical equivalent (SE), mean absolute error (MAE), prediction error, intraocular pressure (IOP), and the influence of surgical technique and IOL characteristics.

Results

Mean refractive astigmatism decreased from 2.29 ± 1.02 D to 0.57 ± 0.44 D at 6 months (p < 0.001). Mean SE improved from −1.38 ± 3.52 D to 0.06 ± 0.45 D. The MAE was 0.59 ± 0.40 D. No significant correlation was found between refractive results and surgical technique or IOL type. Complete IOP control without medication was achieved in 88.3% of eyes. Visual acuity improved in 97.6% of patients

Conclusions

Combined glaucoma filtering surgery with toric IOL implantation yields effective astigmatism correction and favorable refractive outcomes without compromising IOP control. This approach is a valuable option for patients with moderate-to-severe glaucoma and preexisting corneal astigmatism.