Comparison of rotational stability and repositioning rates of 2 presbyopia-correcting and 2 monofocal toric intraocular lenses

Purpose: To compare the rotational stability of 2 commonly used toric presbyopia-correcting (PC) intraocular lenses (IOLs) and their monofocal toric counterparts. Setting: Single 2-surgeon private practice. Design: Retrospective study. Methods: This study included 2 cohorts: (1) all eyes receiving a toric ReSTOR (n = 61 eyes, 49 patients) or toric Symfony (n = 779 eyes, 520 patients) IOL from September 2016 to January 2019; and (2) all eyes receiving an AcrySof (n = 2 393) or TECNIS (n = 731) monofocal toric IOL (TIOL) from April 2015 to January 2019. Eyes were only excluded if digital marking could not be used. 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 IOL was more likely to rotate 5 degrees or less than the toric Symfony IOL, 91.8% vs 79.0% ( P = .01). This remained true for rotation of 10 degrees or less (100% vs 89.5%, P < 0.003). The mean rotation was 2.3 degrees for toric ReSTOR IOL compared with 4.5 for toric Symfony IOL ( P = .01). Statistically significantly more eyes with toric Symfony IOL required a return to the operating room for repositioning (6.9% vs 0%, P < .03). More TECNIS monofocal TIOL eyes required surgical repositioning than AcrySof monofocal TIOL eyes (3.5% vs 1.2%, P < .001). Conclusions: Between these PC-TIOLs, the Symfony IOL was more likely to rotate and to require surgical repositioning than the ReSTOR IOL. The TECNIS TIOL built on the same platform as the Symfony IOL was more likely to require surgical repositioning than that by the AcrySof TIOL. Despite comparable rotational stability between the Symfony and TECNIS monofocal TIOLs, the Symfony was twice as likely to require surgical repositioning.