Rotational Stability of Monofocal and Trifocal Intraocular Toric Lenses With Identical Design and Material but Different Surface Treatment

PURPOSE: To compare the rotational stability, total misalignment, and visual and refractive outcomes achieved with a trifocal toric versus a monofocal toric intraocular lens (IOL). METHODS: In this prospective, interventional case series, eyes of patients consecutively scheduled for cataract surgery who had clinically relevant astigmatism were implanted with a FineVision Pod FT trifocal toric IOL or an Ankoris monofocal toric IOL (both PhysIOL SA, Liege, Belgium). Certain comorbidities, such as pseudoexfoliation syndrome, were allowed. IOL rotation and total misalignment were analyzed 15 minutes, 1 day, 1 week, 6 weeks, 6 months, and 1 year postoperatively. RESULTS: Seventy-one eyes of 53 patients were assessed: 37 eyes were implanted with the trifocal IOL and 34 eyes with the monofocal IOL. More IOL rotation occurred in the monofocal group compared to the trifocal group (mean 4.23° ± 4.64° vs 2.55° ± 2.62°; P = .043, 12 months). Mean total misalignment was higher in the monofocal group (6.67° ± 6.59° at 12 months vs 3.79° ± 3.59° in the trifocal group) (P = .017). Postoperatively, more eyes achieved a refractive cylinder of 0.50 diopters or below in the trifocal group (65% at 12 months) than in the monofocal group, even in the monofocal subgroup analysis that excluded keratoconic eyes (42% at 12 months; P = .009). CONCLUSIONS: The monofocal and trifocal toric IOLs both appear to effectively reduce refractive astigmatism and provide good visual acuity in astigmatic patients having cataract surgery. The trifocal toric IOL offers better rotational stability than the monofocal IOL, probably due to the higher frictional coefficient of its surface. [J Refract Surg. 2018;34(2):84-91.].