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EW INTERNATIONAL
November 2016
and think that the use of toric IOLs
in cataract surgery in children is a
safe and effective way to correct con-
comitant astigmatism," she said. EW
to prevent amblyopia. Dr. Yugay
explained that at times, second-eye
surgery is postponed for 1 to 2
months, due to the risks imposed by
general anesthesia.
Calculating IOL power
"Although we operate on young pa-
tients who have congenital cataract
as early as 4 months of age, we do
not implant toric IOLs in patients
younger than 4 years old for a num-
ber of reasons. First of all, you need
to be able to communicate with the
patient. For instance, when marking
the axis before surgery, the patient
needs to be vertical, sometimes
requiring sedation. Anesthesia and
sedation can be used from 4 years
and onward. There are also challeng-
es in calculating IOL power, as you
need to be able to interact with the
patient when using the IOLMaster
[Carl Zeiss Meditec, Jena, Germany].
The patient needs to sit upright and
look forward," Dr. Yugay said.
According to Dr. Yugay, the best
way to calculate IOL power is using
the SRK/T formula, followed by a
corrective formula to decrease the
IOL power according to the age of
the patient. Once the IOL power has
been calculated, she implements the
AcrySof Toric online calculator to
calculate the cylinder. "The youngest
patient we operated on with congen-
ital cataract was 4 months old. The
IOL power was decreased from 40
D to 30 D. Even in this case, it was
not easy to implant the lens into the
capsular bag, as the capsular bag is
very small. This is why we try not to
implant toric IOLs in patients under
4 years. After 4 years of age, howev-
er, we think that implanting toric
IOLs works well. We use the AcrySof
IQ Toric IOL because of its rotational
stability and the good quality of the
platform.
"The necessity of astigmatism
correction is obvious. Implanting
a toric IOL benefits children who
generally do not like wearing glasses
or contact lenses. Visual results
were good in pediatric patients who
received toric IOLs due to congenital
cataract and concomitant astigma-
tism. I must mention that it was not
only visual acuity, however, that
improved, but the children's social
behavior as well. They communi-
cated better and more easily and
performed well at school. We were
very happy with the overall results
Reference
1.Watanabe T, et al. Corneal astigmatism in
children with congenital cataract. Nippon
Ganka Gakkai Zasshi. 2014;118:98–103.
Editors' note: Dr. Yugay has no finan-
cial interests related to her comments.
Contact information
Yugay: mariayugay@inbox.ru
