Korean J Ophthalmol.  2019 Feb;33(1):36-45. 10.3341/kjo.2018.0041.

Efficacy of 4-Haptic Bitoric Intraocular Lens Implantation in Asian Patients with Cataract and Astigmatism

  • 1Department of Ophthalmology, Seoul National University College of Medicine, Seoul, Korea. kmk9@snu.ac.kr
  • 2Laboratory of Ocular Regenerative Medicine and Immunology, Seoul Artificial Eye Center, Seoul National University Hospital Biomedical Research Institute, Seoul, Korea.


To determine the efficacy of 4-haptic bitoric intraocular lens (IOL) implantation in Asian patients with cataract and astigmatism.
A total of 19 eyes with ≤25.0 mm axial length and ≥0.75 diopters (D) corneal astigmatism were included in this prospective non-comparative study. All subjects underwent phacoemulsification with implantation of an AT Torbi 709M IOL. Visual and refractive outcomes as well as toric IOL axis were evaluated during a 3-month follow-up. Errors in predicted residual spherical equivalent were calculated by subtracting predicted residual spherical equivalent from postoperative refraction.
Uncorrected and corrected distance visual acuity improved significantly 3 months after surgery, from 0.43 to 0.05 and from 0.24 to −0.05, respectively. Mean refractive cylinders also decreased significantly, from −1.91 preoperatively to −0.54 D 3 months after surgery. Mean J0 and J45 decreased 3 months postoperatively, from 0.26 to 0.03 D and from 0.24 to −0.06 D, respectively. After 3 months, mean absolute IOL rotation was 1.81°. Errors in predicted residual spherical equivalent showed a hyperopic shift of 0.35 D.
Implantation of 4-haptic bitoric IOL proved to be effective for correcting astigmatism in Asian eyes during cataract surgery.


Asian eye; Astigmatism; AT Torbi IOL; Cataract surgery; Toric intraocular lens

MeSH Terms

Asian Continental Ancestry Group*
Follow-Up Studies
Lens Implantation, Intraocular*
Lenses, Intraocular*
Prospective Studies
Visual Acuity


  • Fig. 1 (A) Anterior segment image showing intraocular lens axis measurement using ImageJ (B) in comparison with the intended axis.

  • Fig. 2 Refractive outcomes over time showing mean preoperative and postoperative values of the (A) spherical error, (B) cylindrical error, and (C) spherical equivalent. *p < 0.05, **p < 0.005, ***p < 0.0005.

  • Fig. 3 Scattergram showing the relationship between predicted and observed (A) spherical error, (B) cylindrical error, and (C) spherical equivalent correction 3 months after surgery. D = diopters.

  • Fig. 4 Refractive astigmatism (A) preoperatively and (B) 1 day, (C) 1 week, (D) 1 month, and (E) 3 months after surgery. The origin of the graph represents an eye free of astigmatism. J0 and J45: Jackson cross cylinders equivalent to the conventional cylinder at axes of 0° and 45°, respectively.

  • Fig. 5 Scattergram showing the relationship between intended and achieved postoperative intraocular lens (IOL) axes 3 months postoperatively.


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