Use of the STAAR Toric IOL to Correct Post-Surgical Astigmatism

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					Use of the STAAR Toric IOL
  to Correct Post-Surgical
  Astigmatism in Children

      Barry A Schechter, MD
          Florida Eye Microsurgical Institute

     Dr. Schechter is a consultant for STAAR Surgical.

                                                        • The STAAR toric intraocular
                                                          lens (IOL) has shown
                                                          promising results in
                                                          correcting preoperative
                                                          astigmatism in adult cataract
                                                          surgery, and may be useful in
                                                          pediatric cataract surgery as
                                                           – The lens is a single-piece
                                                             silicone plate haptic designed to
                                                             correct between 1.5 and 3.5 D
                                                             of astigmatism.
   STAAR Surgical Toric IOL model AA4203TF.

1. Pandey et al. In: Pediatric Cataract Surgery. 2005
     • An inherent potential difficulty with any toric
       IOL is misalignment.1
        – Case series on adults indicate the lens
          maintains orientation (within 5 degrees of
          intended axis) after cataract surgery.1
     • This case series describes the refractive
       outcomes after implantation of the STAAR
       Toric IOL in three pediatric patients with
       surgically induced astigmatism from previous
1. Chang. JCRS 2003

• This was a case series of three pediatric patients (ages at
  presentation: 5, 7, and 10 years) who had undergone
  previous ocular surgery
   – Congenital cataract in two patients (5 and 10 year olds)
      during infancy (patients were left aphakic)
   – Traumatic corneal laceration (7 year old); trauma and
      surgical repair were 1 year prior to cataract surgery
• All patients had a significant level (minimal of 2.5 diopters)
  of surgically induced corneal astigmatism
• IOL Master was utilized to determine IOL power and
  incision site based on Keratometric data
• All 3 patients received the STAAR toric IOL
   – Congenital cataract patients were implanted with the
     lens in the ciliary sulcus (sufficient capsular
     remnants present allowed for safe and maintainable
     placement of IOL orientation and centration)
   – Traumatic corneal laceration patient had the lens
     implanted within the capsular bag
• Follow up was at least 9-12 months after toric lens
  Results: Congenital cataract
• The 5-year-old presented with difficulty using an
  aphakic contact lens, there was 3.25 D of
   – Contact lens was frequently “lost”
      • Increased risk of amblyopia
• Uncorrected visual acuity at 11 months was 20/30
  (topography showed 3D of residual corneal
  cylinder). The IOL remained centered and stable
  in the intended orientation
  Results: Congenital cataract
• The 10-year old presented wearing an aphakic
  contact lens, BCVA of 20/30 and 7 D of
  astigmatism by topography
   – Main complaint was contact lens used for vision
     correction “frequently fell out” when playing sports.
• Postoperative uncorrected visual acuity was 20/25.
   – Topography showed 5.2 D of corneal cylinder at 12
     months post-op. The lens remained perfectly stable,
     fixated in the sulcus
  Results: Traumatic corneal
• The 7-year-old underwent repair of
  laceration one year prior
  – Resulted in 2.25 D of corneal astigmatism
     • Developed a white cataract
• Preoperative visual acuity was counting
  fingers at 1 ft.
• Postoperative uncorrected visual acuity was
  20/30 at 9 months, IOL remained centered
Patient #3-Pre-op, with cataract
   Patient #3 Post-op, toric IOL
corneal laceration easily visualized
   • In a pediatric population with surgically induced
     astigmatism, an implanted toric IOL may be
     utilized to correct astigmatism and thereby
     minimize the possibility of amblyopia.
   • STAAR toric IOL was well tolerated in these 3
     patients, even within the ciliary sulcus.
   • Further studies in the pediatric patient population
     are warranted with longer follow-up to monitor for
     the potential shift in astigmatic axis1,2 over years.

1. CK Patel et al. Ophthalmology 1999. 2. DF Chang. EyeNet 2001.

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