Comparison of rotational stability and repositioning rates of two presbyopia-correcting and two monofocal toric intraocular lenses.

PURPOSE To compare the rotational stability of two commonly used toric presbyopia-correcting (PC) IOLs and their monofocal toric counterparts SETTING:: Single two-surgeon private practice DESIGN:: Retrospective study with two cohorts: (1) all eyes receiving a toric Restor (n=61) or toric Symfony (n=779) IOL September 2016-January 2019; (2) all eyes receiving an Acrysof (n=2,393) or Tecnis (n=731) monofocal toric IOL (TIOL) April 2015-January 2019. Eyes were only excluded if digital marking could not be utilized. METHODS All patients had image-guided digital marking to verify TIOL position at the conclusion of surgery. Postoperative rotation was determined by dilated examination performed later on the day of surgery or the following morning. RESULTS The toric Restor was more likely to rotate ≤5 degrees than the toric Symfony, 91.8% v. 79.0% (p=0.01). This remained true for rotation ≤10 degrees (100% v. 89.5%, p<0.003). Mean rotation was 2.3 degrees for toric Restor compared to 4.5 for toric Symfony (p=0.01). Significantly more toric Symfony eyes required a return to the operating room for repositioning (6.9% v. 0%, p<0.03). More Tecnis monofocal TIOL eyes required surgical repositioning than Acrysof monofocal TIOL eyes (3.5% v. 1.2%, p<0.001). CONCLUSIONS Between these PC-TIOLs, the Symfony was more likely to rotate and to require surgical repositioning than the Restor. The Tecnis TIOL built on the same platform as the Symfony was more likely to require surgical repositioning than the Acrysof TIOL. Despite comparable rotational stability between the Symfony and Tecnis monofocal TIOLs, the Symfony was twice as likely to require surgical repositioning.