ORIGINAL RESEARCH article
Front. Med.
Sec. Ophthalmology
Enhanced Astigmatism Correction Accuracy with Image-Guided Toric ICL Implantation: A Comparative Clinical Analysis with Manual Axis Marking
Ruixia Li 1
Zheng Fu 2
Yang Liu 2
Caiyuan Liu 3
Jianzhang Hu 4
1. The Graduate School of Fujian Medical University,Xiamen University Affiliated Xiamen Eye Center,Eye Institute of Xiamen University, Xiamen University School of Medicine, Xiamen, China
2. The Graduate School of Fujian Medical University, Fuzhou, China
3. Xiamen University Affiliated Xiamen Eye Center,Eye Institute of Xiamen University, Xiamen University School of Medicine, Xiamen, China
4. Department of Ophthalmology,Fujian Medical University Union Hospital, Fuzhou, China
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Abstract
Purpose:This study compared clinical outcomes of toric intraocular collamer lens (TICL) implantation for myopia and astigmatism correction using image-guided navigation versus manual astigmatic marker alignment, evaluating postoperative astigmatism correction accuracy. Methods:A retrospective analysis included 250 patients (467 eyes) undergoing TICL implantation between January and June 2023. Patients were divided into manual (slit-lamp axis marking) and image-guided (navigation-adjusted lens positioning) groups. Preoperative parameters were comparable. Postoperative visual acuity, refraction, and astigmatism vector analysis (TIA, SIA, DV, CI, AE) were assessed at 3 months. Results:No significant differences were observed in preoperative parameters, postoperative spherical equivalent (SE), or corrected distance visual acuity (CDVA) (P>0.05). However, sphere, cylinder, and uncorrected distance visual acuity (UDVA) differed significantly (P<0.05). Vector analysis revealed no intergroup difference in target-induced astigmatism (TIA) (P>0.05), but surgically induced astigmatism (SIA), absolute difference vector (DV), correction index (CI), and nd absolute Angle of Error (AE) showed significant improvements in the image-guided group (P<0.05). Arithmetic AE did not differ between groups (P>0.05). No intraoperative/postoperative complications (e.g., corneal edema, iris prolapse) occurred. Conclusion :Image-guided TICL implantation yielded superior visual outcomes and greater astigmatism correction accuracy compared to manual marking, with no complications reported. This highlights the clinical advantage of navigation systems in optimizing refractive precision.
Summary
Keywords
Alpins vector analysis, Astigmatism, Image-guided, Manual marking, TICL
Received
01 August 2025
Accepted
30 January 2026
Copyright
© 2026 Li, Fu, Liu, Liu and Hu. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
*Correspondence: Jianzhang Hu
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