Effect of Anesthesia Technique on the Postoperative Rotational Stability of Toric Intraocular Lenses

Purpose: To compare the effects of topical versus peribulbar anesthesia on the early rotational stability of toric intraocular lenses (Toric IOLs). Patients and Methods: In this prospective cohort study, 240 eyes undergoing phacoemulsification with Toric IOL implantation at Qingdao Eye Hospital were analyzed. Preoperative ocular parameters were recorded. Postoperative outcomes at 1 day, 1 week, and 1 month included Toric IOL rotation, uncorrected distance visual acuity (UDVA), residual astigmatism, intraocular pressure, and the rate of IOL repositioning. Binary logistic regression identified factors associated with repositioning. Results: Baseline characteristics were similar between groups. On day 1, mean IOL rotation was significantly lower in the peribulbar group (3.61 ± 2.53°) than in the topical group (4.65 ± 5.40°, P =0.003), and UDVA was better ( P =0.046). At 1 week, rotation remained smaller in the peribulbar group ( P =0.040). By 1 month, no significant differences were found in rotation, UDVA, or residual astigmatism. Repositioning occurred in 1/112 (0.9%) peribulbar and 8/116 (6.9%) topical cases ( P =0.034). Logistic regression confirmed anesthesia type as an independent factor for repositioning ( P =0.045). Conclusion: Peribulbar anesthesia enhances early postoperative rotational stability of Toric IOLs and reduces the need for repositioning. Keywords: Toric IOL, cataract surgery, repositioning, rotational stability, anesthesia