Abstract
BACKGROUND: Manual and digital-assisted marking are the two main marking methods used for toric intraocular lens (IOL) in cataract surgery. However, there is a lack of consensus regarding the consistency in accuracy for these two methods. This meta-analysis aimed to compare and evaluate the accuracy of digital and manual marking techniques for toric IOL alignment during cataract surgery. METHODS: A comprehensive search was conducted using PubMed, Embase, and Cochrane Library databases to identify studies that compared the effectiveness of these two techniques in positioning toric IOLs. The primary outcome measures included postoperative uncorrected distance visual acuity (UDVA), corrected distance visual acuity (CDVA), mean deviation from target-induced astigmatism, and postoperative IOL misalignment. Statistical analyses were performed using RevMan 5.3 software. RESULTS: This meta-analysis included four randomized controlled trials and three retrospective studies comprising 197 eyes in the digital marking group and 206 eyes in the manual marking group for comparative analyses. The statistical meta-analysis indicated no significant differences in postoperative UDVA (logMAR) between the two groups (P = 0.69). Additionally, the meta-analysis showed no significant differences in postoperative CDVA (logMAR) between the two groups (P = 0.29). However, the meta-analysis findings highlighted a significant reduction in the degree of postoperative IOL misalignment in the digital marking group compared to the manual marking group (P = 0.0001). CONCLUSIONS: The results of this meta-analysis offer compelling evidence that the digital marking technique resulted in a lower postoperative IOL misalignment rate than that for the traditional manual marking technique. Both marking methodologies were encouraged in clinical practice because of their effectiveness and accuracy; although, the digital marking technique was generally preferred and highly recommended. TRIAL REGISTRATION: The protocol of this study was registered in PROSPERO (registration ID: CRD420251045237).