The comparative analysis of the effectiveness of implantation of toric, spherical and aspherical intraocular lenses for the surgical treatment of congenital cataract

Objective. The comparative analysis of the outcomes of the surgical treatment of the children presenting with congenital cataract and astigmatism following the implantation of toric, spherical, and aspherical intraocular lenses (IOLs). Materials and methods. A total of 97 children (127 eyes) presenting with congenital cataract were selected for the present study. Group 1 consisted of the patients suffering from corneal astigmatism of more than 1,0 D who had undergone toric IOLs implantation (25 children, 38 eyes). Group 2 was comprised of the patients with corneal astigmatism of more than 1,0 D who had undergone implantation of spherical and aspherical intraocular lenses (40 children, 48 eyes). Group 3 was composed of 32 children (41 eyes) with corneal astigmatism of less than 1,0 D who had undergone implantation of non-toric intraocular lenses. Lensectomy was performed with the use of the small (1,8 mm and 2,2 mm) incision technique. Various IOL models (Alcon, USA) were used for implantation. The vector analysis of astigmatic correction (Alpinus) was employed to evaluate the quality of astigmatism correction. Results. The patients of all groups experienced a significant improvement of postoperative non-correctable and maximally correctable visual acuity during the long-term follow-up period (over 3 years in duration). In the children comprising group 1, the estimated value of vector astigmatism (-0,72) was close to the actual postoperative value (-0,81). The TIA axis was 113,7 degrees and the SIA axis 92,6 degrees. The vector difference was 0,18 diopters which suggested the high precision of astigmatism correction. The correction index averaged 1,12 ± 0,14. The IOL index was 0,25 ± 0,16 in comparison with its ideal value of 0.0. In the children of group 2, the estimated value of vector astigmatism (-0,87) was significantly higher than the actual postoperative values (-0,56). The TIA axis was 134,3 degrees and the SIA axis 77,1 degrees (p <0,05). Conclusion. The removal of congenital cataract and implantation of toric IOLs for the management of the children presenting with initial astigmatism provides an efficient and safe method for the surgical treatment of this condition. The comparative analysis of the functional results of such approach for the patients of different groups has demonstrated a significantly better correction of astigmatism in the patients treated with the use of implantation of toric intraocular lenses.

congenital cataract, astigmatism, toric intraocular lenses