To compare the accuracy of toric intraocular lens (IOL) alignment and visual outcomes using femtosecond laser-assisted capsulotomy marking (CM) versus conventional slitlamp-assisted manual marking (MM).
Prospective cohort study.
57 patients requiring cataract surgery and toric IOL implantation (Acrysof SN6AT3-T8) were assigned to the CM group (26 eyes) or the MM group (31 eyes). Uncorrected distant visual acuity (UCDVA), best corrected distant visual acuity (BCDVA), residual astigmatism (RA), IOL misalignment, and modulation transfer function (AR value) were measured one month and three months after surgery.
Postoperative UCDVA (LogMAR) was significantly lower in the CM group than in the MM group (P < 0.05). Postoperative RA and IOL misalignment were significantly lower in the CM than in the MM group (both P 0.05). UCDVA (LogMAR) was positively correlated with RA (r = 0.339; P < 0.05) and IOL misalignment (r = 0.317; P < 0.05) and negatively correlated to the AR value (r = -0.272; P < 0.05); RA was positively correlated with IOL misalignment (r = 0.405; P < 0.05).
The accuracy of the axis alignment was significantly higher in the CM group, which resulted in lower residual astigmatism and better visual outcomes.

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