1. 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.

2. 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.
Full references:
1. Pandey SK, Olsen RJ. Posterior chamber lens implants: Currently available lens designs and future application. In: Wilson ME, Trivedi RH, Pandy SK, eds. Pediatric Cataract Surgery. Philadelphia, PA: Lippincott Williams & Wilkins; 2005:
STAAR Surgical Toric IOL model AA4203TF.
1. Pandey et al. In: Pediatric Cataract Surgery. 2005

3. 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.
Full references:
1. Chang DF: Early rotational stability of the longer Staar toric intraocular lens: fifty consecutive cases. J Cataract Refract Surg 2003, 29:
1. Chang. JCRS 2003

4. 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

5. 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

6. 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

7. 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

8. 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

9. Patient #3-Pre-op, with cataract

10. Patient #3 Post-op, toric IOL corneal laceration easily visualized

11. 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.
Full reference:
Patel CK, Ormonde S, Rosen PH, Bron AJ. Postoperative intraocular lens rotation: A randomized comparison of plate and loop haptic implants. Ophthalmology. 1999;106(11):
Chang DF. Pearls for implanting the Staar Toric IOL. EyeNet magazine Available online: Accessed Feb. 3, 2009.
1. CK Patel et al. Ophthalmology DF Chang. EyeNet 2001.