Transcript Document

Use of the STAAR Toric IOL
to Correct Post-Surgical
Astigmatism in Children
Barry A Schechter, MD
Florida Eye Microsurgical Institute
Email [email protected]
Dr. Schechter is a consultant for STAAR Surgical.
Introduction
• 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
well.1
– 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
Introduction
• 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
surgery.
1. Chang. JCRS 2003
Methods
• 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
Methods
• 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
implantation
Results: Congenital cataract
• The 5-year-old presented with difficulty using an
aphakic contact lens, there was 3.25 D of
astigmatism
– 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
laceration
• 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
Discussion
• 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.