Case-Control Study of Toric Intraocular Lens Implantation in Congenital Cataract.

Purpose: To evaluate the visual and refractive outcomes after toric intraocular lens (IOL) implantation compared to monofocal IOLs in pediatric eyes with cataracts and preexisting corneal astigmatism.

Methods: This case-control study was performed on 37 eyes of 37 children older than six years with visually significant congenital cataracts and corneal astigmatism greater than 1.75 diopters (D). The patients underwent lens aspiration with either monofocal (19 eyes) or toric (18 eyes) IOL implantation between June 2021 and December 2022. Uncorrected distance visual acuity (UCVA), corrected distance visual acuity (CDVA), near visual acuity, keratometry data, and residual astigmatism were evaluated preoperatively and on the fifth day as well as the first, third, and sixth months postoperatively.

Results: Preoperative mean corneal astigmatism was 2.84 $\pm$ 0.51 D in the toric group and 3.05 $\pm$ 0.79 D in the non-toric group (P = 0.563). At the final follow-up, postoperative refractive astigmatism was 0.53 $\pm$ 0.33 D in the toric group and 2.33 $\pm$ 0.8 D in the non-toric group (P $<$ 0.001). CDVA of 20/40 or better was achieved in 83.3% (n = 15) and 47.4% (n = 9) of eyes in the toric and non-toric groups, respectively (P = 0.038). Also, corrected near visual acuity of 20/40 or better was achieved in 100% (n = 18) and 78.9% (n = 15) of eyes in the toric and non-toric groups, respectively (P = 0.105).

Conclusion: The study shows that pediatric cataract surgery with toric IOL implantation is an effective method of correcting preexisting corneal astigmatism. Compared to monofocal IOL implantation, it achieves better CDVA and near visual acuity.