Three-Year Outcomes of Toric vs Nontoric Monofocal Intraocular Lens Implantation in Children Aged 3-8 Years With
Lei Cai1, Runhan Shi1, Xuanqiao Lin1
1Department of Ophthalmology (L.C., R.S., X.L., X.Z., Y.H., X.H., Z.H., W.S., J.H., J.Y.), Eye, Ear, Nose, and Throat Hospital of Fudan University, Shanghai, PR China; Key Laboratory of Myopia (L.C., R.S., X.L., X.Z., Y.H., X.H., Z.H., W.S., J.H., J.Y.), Ministry of Health, Shanghai, PR China; Shanghai Key Laboratory of Visual Impairment and Restoration (L.C., R.S., X.L., X.Z., Y.H., X.H., Z.H., W.S., J.H., J.Y.), Shanghai, PR China; Visual Rehabilitation Professional Committee (L.C., R.S., X.L., X.Z., Y.H., X.H., Z.H., W.S., J.H., J.Y.), Chinese Association of Rehabilitation Medicine, Shanghai, PR China.
Objective:
To compare 3-year visual outcomes of toric and nontoric intraocular lens (IOL) implantation in children aged 3-8 years with congenital cataracts and ≥2.0D corneal astigmatism.
Design:
Prospective, nonrandomized, comparative, single-center clinical study SUBJECTS: We enrolled children with congenital cataract who had ≥2.0D corneal astigmatism and were aged 3 to 8 years. Among 236 eligible patients, we included 194 who completed the 3-year follow-up.
Interventions:
Participants underwent toric IOL implantation (toric group) or nontoric monofocal IOL implantation (nontoric group) based on the parental preference.
Main Outcome Measures:
The primary outcome was corrected distance visual acuity (CDVA) during the 3-year follow-up period, which was measured in logMAR units.
Results:
Among the 194 participants (75 [38.7%] female), there were 106 and 88 patients in the nontoric and toric groups, respectively. Both groups demonstrated significant improvements in uncorrected distance visual acuity (UDVA) and CDVA at the endpoint (P < .001). At 3 years, the toric group had a significantly better mean CDVA than the nontoric group (P = .003). The toric group had a significantly higher proportion of eyes that achieved nonamblyopic vision (CDVA ≥ 0.8) than the nontoric group (86.4% vs. 69.8%, P = .009). In the subgroup analysis, among patients with preoperative corneal astigmatism >3.0 D, the toric group exhibited significantly better CDVA than the nontoric group from 3 months to 3 years postoperatively (P < .001). Contrastingly, among patients with astigmatism ≤ 3.0 D, there was no significant between-group difference in CDVA. Notably, the toric group demonstrated significantly lower postoperative refractive astigmatism than the nontoric group throughout the follow-up period (P < .05). None of the patients rotated ≥ 10° or required IOL repositioning surgery.
Conclusions:
For children aged 3 to 8 years with congenital cataracts and corneal astigmatism ≥2.0 D, toric IOL implantation provided superior long-term visual outcomes and reduced amblyopia rates compared with nontoric monofocal IOL implantation. This supports its consideration as the preferred surgical approach for optimizing visual rehabilitation in this population.
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