To compare the effectiveness of toric intraocular lens (IOL) implantation and monofocal IOL implantation with a limbal relaxing incision (LRI) for correcting astigmatism in the Korean population.

The medical records of 79 patients (100 eyes) with corneal astigmatism over 1.25 diopters (D) who underwent toric IOL implantation (toric group; 54 eyes), monofocal IOL implantation with a concurrent LRI (LRI group; 24 eyes), or monofocal IOL implantation without correcting astigmatism (control group; 22 eyes), were retrospectively reviewed. For subgroup analyses, the three groups were subdivided according to preoperative astigmatic severity under 2.5 D. Visual, refractive, and keratometric outcomes were compared 2 and 6 months postoperatively.

The uncorrected distance visual acuity was at least 20/25 (0.1 logMAR) in 64.8%, 41.7%, and 27.3% of the toric, LRI, and control group eyes, respectively at 2 months after surgery. The toric group had the greatest refractive cylindrical error change (toric group, −2.48 ± 1.84 D to −0.98 ± 0.92 D; LRI group, −2.02 ± 1.03 D to −1.65 ± 0.86 D; control group, −1.69 ± 0.88 D to −1.49 ± 0.60 D; p < 0.001) and the LRI group showed the greatest mean corneal cylindrical error change (toric group, 2.40 ± 1.33 D to 2.23 ± 1.42 D; LRI group, 1.86 ± 0.44 D to 1.29 ± 0.55 D; control group, 1.60 ± 0.39 D to 1.35 ± 0.60 D; p = 0.025). The 85 eyes with moderate corneal astigmatism (between 1.25 D and 2.5 D) were under evaluation. The toric group showed the highest mean refractive cylindrical change (0.97 ± 0.66 D; p < 0.001), followed by the LRI group (0.53 ± 0.87 D; p = 0.046).

Both surgical techniques significantly reduced astigmatism and had comparable visual outcomes. Toric IOL implantation was more reliable for correcting astigmatism than monofocal IOL implantation with a concurrent LRI regardless of the preoperative astigmatic severity. Both procedures were effective in reducing astigmatism in eyes with moderate corneal astigmatism.