{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,4,28]],"date-time":"2026-04-28T19:43:25Z","timestamp":1777405405429,"version":"3.51.4"},"reference-count":52,"publisher":"MDPI AG","issue":"9","license":[{"start":{"date-parts":[[2026,4,28]],"date-time":"2026-04-28T00:00:00Z","timestamp":1777334400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JCM"],"abstract":"<jats:p>Background\/Objectives: Toric intraocular lens (IOL) implantation is the standard approach for correcting corneal astigmatism during cataract surgery and refractive lens exchange (RLE). Evidence on outcomes in eyes with high corneal astigmatism (\u22652.00 diopters, D), particularly in heterogeneous real-world settings, remains limited. This study evaluated visual, refractive, and astigmatic vector outcomes of toric IOL implantation in a consecutive high-astigmatism cohort and investigated predictors of residual astigmatic error. Methods: This single-center, single-surgeon retrospective analysis of prospectively collected data included 161 eyes (118 patients) with preoperative corneal astigmatism \u2265 2.00 D undergoing cataract surgery or RLE with toric IOL implantation (June 2023\u2013December 2025). Primary outcomes at one month included visual acuity, manifest refraction, and Alpins vector analysis at the corneal plane. Secondary analyses comprised refractive stability assessment (n = 75 eyes, median seven months), comparison of astigmatic outcomes between emmetropia-targeted and intentional myopia-targeted eyes, and multivariate regression of predictors of residual astigmatic error. Results: Mean postoperative UDVA and CDVA were 0.19 \u00b1 0.24 and 0.09 \u00b1 0.15 logMAR, respectively. Spherical equivalent prediction error was \u22120.19 \u00b1 0.42 D (69.6% within \u00b10.50 D of target). Mean residual cylinder was 0.52 \u00b1 0.49 D; 62% and 88.8% of eyes achieved \u22640.50 D and \u22641.00 D, respectively. Vector analysis demonstrated a mean difference vector of 0.53 \u00b1 0.44 D, a correction index of 1.04 \u00b1 0.20, and near-zero centroid deviation (0.03 D @ 43\u00b0), indicating the absence of systematic directional prediction error. Refractive outcomes were stable at medium-term follow-up. Astigmatic correction accuracy was equivalent between emmetropia-targeted and intentional myopia-targeted eyes (p &gt; 0.05 for all primary metrics). Multivariate regression identified IOL cylinder power (\u03b2 = 0.051, p = 0.031) and oblique astigmatism orientation (\u03b2 = 0.299 vs. WTR, p = 0.032) as independent predictors of greater residual astigmatic error. No sight-threatening complications occurred. Conclusions: Toric IOL implantation provides safe, predictable, and stable correction of high corneal astigmatism in a real-world mixed cohort. Astigmatic accuracy is maintained regardless of intended spherical refractive strategy, supporting the use of toric IOLs in highly myopic patients targeted for residual myopia. Oblique astigmatism orientation is an independent predictor of reduced correction accuracy, consistent with known limitations of current toric calculators for this meridian.<\/jats:p>","DOI":"10.3390\/jcm15093343","type":"journal-article","created":{"date-parts":[[2026,4,28]],"date-time":"2026-04-28T09:55:39Z","timestamp":1777370139000},"page":"3343","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Early Real-World Clinical Outcomes and Astigmatism Vector Analysis of Toric Intraocular Lenses for High Astigmatism (\u22652.0 D)"],"prefix":"10.3390","volume":"15","author":[{"ORCID":"https:\/\/orcid.org\/0009-0006-6096-7565","authenticated-orcid":false,"given":"Silvia Victoria","family":"Prodescu","sequence":"first","affiliation":[{"name":"Doctoral School, Ophthalmology Department, Carol Davila University of Medicine and Pharmacy, 020021 Bucharest, Romania"},{"name":"Ophthalmology Department, Alcor Clinic, 030836 Bucharest, Romania"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9487-2832","authenticated-orcid":false,"given":"Paul Filip","family":"Curc\u0103","sequence":"additional","affiliation":[{"name":"Ophthalmology Department, Central Military Emergency University Hospital \u201cDr. Carol Davila\u201d, Carol Davila University of Medicine and Pharmacy, 010825 Bucharest, Romania"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4998-228X","authenticated-orcid":false,"given":"C\u0103t\u0103lina Ioana","family":"T\u0103taru","sequence":"additional","affiliation":[{"name":"Ophthalmology Department, Alcor Clinic, 030836 Bucharest, Romania"},{"name":"Ophthalmology Department, Clinical Institute for Ophthalmological Emergencies \u201cProf. Dr. Mircea Olteanu\u201d, Carol Davila University of Medicine and Pharmacy, 010464 Bucharest, Romania"},{"name":"Ophthalmology Department, Clinical Institute for Ophthalmological Emergencies \u201cProf. Dr. Mircea Olteanu\u201d, 010464 Bucharest, Romania"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0009-0003-6335-3567","authenticated-orcid":false,"given":"C\u0103lin Petru","family":"T\u0103taru","sequence":"additional","affiliation":[{"name":"Ophthalmology Department, Alcor Clinic, 030836 Bucharest, Romania"},{"name":"Ophthalmology Department, Central Military Emergency University Hospital \u201cDr. Carol Davila\u201d, Carol Davila University of Medicine and Pharmacy, 010825 Bucharest, Romania"},{"name":"Ophthalmology Department, Clinical Institute for Ophthalmological Emergencies \u201cProf. Dr. Mircea Olteanu\u201d, 010464 Bucharest, Romania"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1968","published-online":{"date-parts":[[2026,4,28]]},"reference":[{"key":"ref_1","first-page":"693","article-title":"Refractive errors","volume":"113","author":"Schiefer","year":"2016","journal-title":"Dtsch. 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