Comparison of manual marking and femtosecond laser–assisted capsular marking methods for toric intraocular lens alignment

PURPOSE: To compare the effectiveness of femtosecond laser-assisted capsular marking and manual slit-lamp marking methods in correcting astigmatism during cataract surgery, for accurate positioning of toric intraocular lenses (IOLs). METHODS: The medical records of 35 eyes that underwent preoperative manual marking with implantation of AcrySof IQ PanOptix (Alcon Laboratories, Fort Worth, TX) toric trifocal lens (Group 1), and 35 eyes that underwent the same toric trifocal lens implantation using femtosecond laser IntelliAxis software (Group 2), between 2019 and 2024, were retrospectively reviewed. Pre- and postoperative uncorrected and corrected visual acuity, preoperative corneal astigmatism, postoperative residual astigmatism, and slit-lamp and fundus examinations were evaluated. RESULTS: In the manual-marking group, the mean preoperative corneal astigmatism was 2.11 ± 0.66 D, while the postoperative astigmatism was 0.51 ± 0.17 D. In the femtosecond laser marking group, the mean preoperative corneal astigmatism was 2.06 ± 0.61 D, and the postoperative astigmatism was 0.38 ± 0.13 D. Both groups demonstrated a statistically significant reduction in astigmatism values before and after surgery ( P < 0.05). Postoperative residual astigmatism was lower in the femtosecond group, and the difference between the two groups was statistically significant ( P < 0.05). CONCLUSION: Both femtosecond laser-assisted and manual-marking methods are effective techniques for toric lens alignment. However, the femtosecond laser-assisted method was found to be statistically superior in correcting astigmatism. Additionally, femtosecond laser marking offers several advantages over manual marking. It is less surgeon-dependent, requires less experience, shortens the procedure time, and eliminates ink-related complications during surgery.