AIM:To compare the accuracy of Toric intraocular lens(IOL)alignment using the Verion image guided system and conventional manual marker.

METHODS:Prospective randomized controlled study. A total of 56 eyes of 47 age-related cataract patients who underwent phacoemulsification combined with Toric IOL implantation in our hospital from June 2016 to December 2019 were randomly divided into two groups:In the image-guided group, Verion navigation system collected anterior segmental images before surgery, and Toric target was set to 27 eyes in axial direction. In the marker group, Toric target was marked at 0° and 180° levels before surgery, and Toric target was marked in 29 eyes in axial direction according to the labeling ring. At 1h, 1wk, 1 and 3mo postoperatively, the anterior segment of patients with dilated pupil was photographed. Photoshop software was used to analyze the deviation between the actual axial direction and the target axial direction of the two groups, and the patients' naked eye visual acuity(UCDVA), best corrected visual acuity(BCDVA)and residual astigmatism were recorded.

RESULTS: At 1h and 3mo postoperatively, the deviation between the actual axis and the target axis of IOL in the navigation group was less than that in the marker group(1.5°±1.8° vs 3.1°±2.1°; 1.9°±1.6° vs 3.3°±2.4°, all P<0.05). There was no difference in UCDVA(LogMAR)between the navigation group and the marker group(0.04±0.08 vs 0.06±0.07, P=0.338)and there was no difference in residual divergence(-0.39±0.32 vs -0.45±0.31D, P=0.491)between two groups at 3mo after operation.

CONCLUSION:Verion digital marking and manual marking showed high accuracy in marking Toric IOL axial direction. Although the navigation group showed no advantage in UCDVA and residual astigmatism, the IOL misalignment in navigation group was significantly smaller than the marker group, and Toric IOL axial direction was implanted more accurately under Verion digital marking.