Three-Year Outcomes of Toric vs Nontoric Monofocal Intraocular Lens Implantation in Children Aged 3–8 Years With Congenital Cataract

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.