Effect Of Toric Intraocular Lens Implantation On Pediatric Cataract With Preexisting Corneal Astigmatism

Aim:Toric intraocular lens(IOL)implantation is effective in adults cataract surgery,but there are few reports on the effects of Toric IOL implantation in children with cataract and preexisting high corneal astigmatism.The purpose of this study was to evaluate effectiveness,safety,predictability and stability of the Toric IOL for pediatric cataract and preexisting corneal astigmatism and to provide some reference value for the surgical treatment of pediatric cataract with preexisting corneal astigmatism.Methods:This study included 17 patients(26 eyes)from January 2017 to August 2019 in the first affiliated Hospital of Guangxi Medical University.9patients(16 eyes)underwent cataract phacoemulsification and Toric IOL(Toric group)implantation,of which 4 eyes underwent posterior capsulotomy combined with anterior vitrectomy;and 8 patients(10 eyes)underwent cataract phacoemulsification and non-toric IOL(control group)implantation,of which 3eyes underwent posterior capsulotomy combined with anterior vitrectomy.The patients aged from 4 to 14 years old and the eyes with corneal astigmatism of1.5 diopters(D)or more.We use uncorrected distance visual acuity(UDVA)and corrected distance visual acuity(CDVA)collected before surgery,at 1month and 6 months after surgery to evaluate effectiveness,which is also evaluated by astigmatism at 1 month and 6 months after surgery.Amblyopia and the postoperative complications such as intraocular hypertension and posterior cataract were observed and recorded to evaluate the safety.the achieved astigmatism at 6 months after surgery and the attemped postoperative astigmatism were used to evaluate the predictability;the axial position at 1month and 6 months after surgery of IOL were collected to evaluate the rotational stability.Result:(1)Visual acuity: In Toric group,the median UDVA(Log MAR)before surgery,1 month and 6 months after surgery were 1.1,0.35 and 0.30,respectively.The UDVA at 1 month and 6 months after surgery were both better than that before surgery(P<0.05).In Toric group,the median CDVA(Log MAR)before surgery,1 month and 6 months after surgery were 0.70,0.22 and 0.19,respectively.The CDVA at 1 month and 6 months after surgery were both better than that before surgery(P<0.05).There was no significant difference in preoperative UDVA between the Toric group and the control group(P=0.690),but the UDVA at 1 month and 6 months after surgery in Toric group were both better than that in Toric group(P<0.05).And there was no significant difference in CDVA between the two groups before operation,at 1 month and 6 months after surgery(P>0.05).(2)Astigmatism : The median astigmatism at 6 months after surgery of Toric group and control group were 0.63 D and 2.0D(P=0.002),respectively.At 6months after surgery,the median correction of astigmatism of Toric group and control group were 2.15 D and 0.50 D,respectively.And there was significant difference between the two groups(P < 0.001).(3)Complications and amblyopia: In Toric group,3 eyes(18.75%)had corticosteroid-induced ocular hypertension,1 eye(6.25%)had posterior cataract 3 months after surgery,and 3eyes(18.75%)had amblyopia.There were no other serious complications.In the control group,2 eyes(20%)had corticosteroid-induced ocular hypertension and3 eyes(30%)had amblyopia.There were no other serious complications.There was no significant difference in the incidence of corticosteroid-induced ocular hypertension,posterior cataract and amblyopia between the two groups(P>0.05).(4)The predictability and the axial position: In Toric group,12 eyes were within ±1.0D of attempted astigmatism at 6 months after surgery.In Toric group,the median rotation of IOL at 1 month and 6 months after surgery was1.0 °and 1.0 °,respectively(P>0.05).(5)Posterior capsule and its related conditions: In Toric group,there was no significant difference in axial rotation of IOL and astigmatism at 6 months after surgery between posterior capsulotomy Toric groupnd posterior uncapsulotomy group(P>0.05).Conclusion: Phacoemulsification combined with Toric IOL implantation can effectively correct the preexisting corneal astigmatism and thus improve the UDVA after surgery.And Toric IOL implantation has good safety,predictability and stability for pediatric cataract with preexisting corneal astigmatism,and intraoperative posterior capsulotomy does not affect the postoperative rotational stability of Toric IOL.