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Outcomes of toric supplementary intraocular lenses for residual astigmatic refractive error in pseudophakic eyes

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To evaluate rotational stability and visual and refractive outcomes of supplementary toric IOLs (Sulcoflex Toric 653T, Rayner Intraocular Lenses Ltd) for residual astigmatic refractive error in pseudophakic eyes.


A retrospective interventional case series was conducted in a single surgeon practice. Charts of patients who had Sulcoflex Toric supplementary IOLs inserted between June 2009 and September 2015 were reviewed. Outcomes were compared between eyes with and without prior corneal transplant. Patients with at least 3-months follow-up were included.


In 51 eyes, mean UDVA improved from 20/86 to 20/43 (p = 0.002), though UDVA was better in eyes without corneal grafts (20/31) than eyes with (20/62). The proportion of eyes achieving 20/20 UDVA was 43%, 61% and 17% overall, in eyes with prior graft and in eyes with no prior graft, respectively. Sixty-four percentage achieved a spherical equivalent of within 0.5D of target (84% no graft, 34% prior graft). Fifty-three percentage of eyes achieved a cylinder of within 0.5D of target (no graft: 73%, prior graft: 0%). Mean lens rotation was 8.23° on day 1, and mean maximal rotation during follow-up was 17.63°. Sixty-two percentage of IOLs required repositioning. Of those that required repositioning, this was conducted a mean of 2.3 times. The mean final IOL rotation (following repositioning if required) was 6.17°.


Sulcoflex Toric supplementary IOLs result in good visual and refractive outcomes in eyes with no prior corneal graft. However, outcomes are sub-optimal in eyes with prior corneal transplantation, and the majority of lenses require repositioning.

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Correspondence to Cameron A. McLintock.

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All authors declare no conflict of interest.

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All procedures performed were in accordance with the ethical standards of the involved institutions and with the 1964 Declaration of Helsinki and its later amendments. Ethics approval was obtained from the Metro South Human Research Ethics Committee (Brisbane, Australia). Informed consent was obtained from all individual participants included in the study.

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McLintock, C.A., McKelvie, J., Gatzioufas, Z. et al. Outcomes of toric supplementary intraocular lenses for residual astigmatic refractive error in pseudophakic eyes. Int Ophthalmol 39, 1965–1972 (2019).

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