Toric IOLs: When and When Not to Use in Glaucomatous Eyes
Implanting these lenses during combined phacoemulsification and glaucoma surgery is nuanced.
Gio Campagna, MD
Glaucoma Today 
Key Takeaways Toric IOLs can be safely implanted during angle surgery, in combination with filtration surgery, or after any type of glaucoma surgery, and many patients will achieve a good refractive outcome. When toric IOL implantation is combined with filtration surgery, especially trabeculectomy or aqueous shunt placement, the refractive outcome may be unstable for several months postoperatively, so thorough preoperative counseling is required. Monofocal IOLs are an excellent choice for patients with glaucoma. For those who also have visually significant regular corneal astigmatism, toric monofocal IOLs can provide sharper and clearer distance or near UCVA without splitting light or worsening their contrast sensitivity.1 Many glaucoma surgeons consider a toric monofocal IOL to be an appropriate option for patients with good central visual potential. The subtype of glaucoma is relevant. Pseudoexfoliation, trauma, and chronic angle closure can result in zonulopathy, which may put the IOL at greater risk of tilt, decentration, rotation, or dislocation. Implanting a toric IOL during combined phacoemulsification and glaucoma surgery requires special consideration. The importance of preoperative counseling cannot be overstated. PHACOEMULSIFICATION COMBINED WITH TORIC IOL IMPLANTATION AND ANGLE SURGERY MIGS is commonly performed at the time of cataract surgery and toric IOL implantation and generally achieves good, predictable refractive outcomes. The refractive outcomes of cataract surgery alone, cataract surgery with goniotomy, and cataract surgery with a trabecular meshwork bypass stent are clinically similar.2 Patients and physicians alike can have confidence that the placement of a toric IOL at the time of cataract surgery combined with an angle procedure (eg, stenting, goniotomy, canaloplasty, and procedural pharmaceutical placement) will have a favorable refractive outcome.