Objective Rotational Analysis of EVO Toric ICLs Using Infrared Retinal Retroillumination Imaging

<b>Background/Objectives:</b> To objectively evaluate the rotational stability, refractive predictability, and visual outcomes of toric EVO ICL using automated infrared retinal retroillumination imaging. Setting/Venue: The research was conducted in a specialized ophthalmic surgery center. Design: Longitudinal analytical prospective study. <b>Methods:</b> The methodology included preoperative and postoperative assessments of visual acuity, subjective refraction, corneal topography, and anterior segment OCT. The implantation and alignment process utilized advanced digital centration techniques. Postoperative evaluations were conducted at 1 and 3. <b>Results:</b> The study found a mean incision surgically induced astigmatism (SIA) of 0.32 D, and a refractive SIA average of 2.02 D, closely matching the preoperative refractive astigmatism (target-induced astigmatism-TIA) mean of 2.07 D, resulting in a correction index (CI) of 0.96. Rotational stability was high, with 72% of lenses showing less than 5° rotation and 96% under 10° at the 1-month follow-up. No significant correlations were observed between lens rotation and postoperative vault size or horizontal compression, indicating independent factors. The discrepancy between theoretical and observed rotations suggested that the calculation method slightly underestimated actual rotation, which did not significantly affect visual outcomes. Graphical analysis demonstrated minimal impact of lens rotation on uncorrected distance visual acuity (UDVA), confirming the procedure's efficacy and safety. <b>Conclusions</b>: Toric EVO ICL implants provide high rotational stability, excellent refractive predictability, and satisfactory visual outcomes. The study underscores the importance of precise implantation and the minimal influence of lens rotation on postoperative refractive errors.