| Description: |
Background: This narrative review aims to assess multiple strategies available to evaluate and manage corneal astigmatism in the context of cataract surgery, with a focus on the surgical techniques, intraocular lens (IOL) selection, and the integration of advanced new technologies. Methods: A narrative review based on a literature search in PubMed/MEDLINE and the Cochrane Library, covering publications from 1990 to 2025, was conducted. Eligible studies included randomized controlled trials, observational studies, prospective and retrospective analyses, and systematic reviews. Key search terms included “astigmatism”, “cataract surgery”, “keratometry”, and “refraction.” Studies were screened and selected by two independent reviewers. Results: Corneal astigmatism is the most common form of astigmatism. While the anterior corneal astigmatism plays a more important role, the posterior corneal astigmatism and the posterior-to-anterior corneal ratio (Gullstrand ratio) can impact the postoperative refractive results in a very important way. While planning the cataract surgery, surgically induced astigmatism (SIA), especially on the posterior cornea, must be taken into consideration. Various approaches, such as opposite clear corneal incisions (OCCIs), toric intraocular lens (IOLs), intraoperative aberrometry, and the integration of artificial intelligence and robotic-assisted surgery, are increasing the precision of astigmatism correction and surgical outcomes. Conclusions: Individualized surgical planning and precise measurement are key factors in reducing residual astigmatism and obtaining the best visual outcomes in patients with corneal astigmatism undergoing cataract surgery. By taking into consideration the posterior corneal data, refining IOL calculations, and embracing the rapidly developing technological innovations, patient satisfaction and visual quality can be substantially improved, and the predictability of the surgical outcome can be enhanced. |