Trifocal toric intra-ocular lens implantation in pediatric t
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Intraocular lens (IOL) implantation in selected pediatric traumatic cataract cases has been performed with good refractive and visual outcomes. The most common procedure in these cases is monofocal IOL implantation, aiming for emmetropia or hyperopia (depending on patient age) with spectacle correction for residual refractive error and loss of accommodation. However, toric and/or multifocal IOLs have been implanted in children in order to reduce post-operative glasses dependency.

Here is the case of a 6-year old girl presented a year after blunt trauma with a hair rubber band to the right eye (OD). Best corrected visual acuity was +0.7 logMar at distance and worse than J6 at 12 inches. Slit lamp examination and ultrasound biomicroscopy showed an anterior subcapsular cataract in the visual axis (Fig. 1). Intraocular pressure (IOP) was 10 mmHg and fundus examination was possible after pupil dilation with no anomalous findings. Potential Acuity Meter (PAM) was +0.1 logMar using infrared light. Topography showed with-the-rule astigmatism of 2.17 D OD and asymmetric astigmatism of 0.55 D in the left eye (OS) . Axial length measurement was performed using B-ultrasound and exported to IOLMaster software.

Desired correction was emmetropia and toric marker positioning was calculated using standard online Zeiss toric calculator.Routine phacoemulsification using 2.75 mm incision was performed under general anesthesia with no complications. On the first postoperative day, the patient was +0.3 logMar without correction and 0.00 logMar with residual refraction of −0,75 spherical diopters (SD). Her vision and refraction were stable at her 1-year post surgery visit.

This was a relatively unusual case in that though this cataract was the result of a trauma, this child did not have any coexisting ocular injuries, which are common in ocular trauma and would have precluded the use of a trifocal or toric IOL. Concerns specifically about refractive shift over time, capsular contraction and potential amblyogenic effects need to be further explored. Larger studies comparing long term outcomes of monofocal and multifocal IOL implantation in children are needed.