Objective: To compare 3-year visual outcomes of toric and non-toric intraocular lens (IOL) implantation in children aged 3-8 years with congenital cataracts and ≥2.0D corneal astigmatism.
Design: Prospective, nonrandomized, comparative, single-center clinical study SUBJECTS: We enrolled children with congenital cataract who had ≥2.0D corneal astigmatism and were aged 3-8 years. Among 236 eligible patients, we included 194 who completed the 3-year follow-up.
Interventions: Participants underwent toric IOL implantation (toric group) or non-toric monofocal IOL implantation (non-toric group) based on the parental preference.
Main outcome measures: The primary outcome was corrected distance visual acuity (CDVA) during the 3-year follow-up period, which was measured in logMAR units.
Results: Among the 194 participants (75 [38.7%] female), there were 106 and 88 patients in the non-toric and toric groups, respectively. Both groups demonstrated significant improvements in uncorrected distance visual acuity (UDVA) and CDVA at the endpoint (P < 0.001). At 3 years, the toric group had a significantly better mean CDVA than the non-toric group (P = .003). The toric group had a significantly higher proportion of eyes that achieved non-amblyopic vision (CDVA ≥0.8) than the non-toric group (86.4% vs. 69.8%, P = .009). In the subgroup analysis, among patients with preoperative corneal astigmatism >3.0 D, the toric group exhibited significantly better CDVA than the non-toric group from 3 months to 3 years postoperatively (P < 0.001). Contrastingly, among patients with astigmatism ≤3.0 D, there was no significant between-group difference in CDVA. Notably, the toric group demonstrated significantly lower postoperative refractive astigmatism than the non-toric group throughout the follow-up period (P<0.05). None of the patients rotated ≥10° or required IOL repositioning surgery.
Conclusions: For children aged 3-8 years with congenital cataracts and corneal astigmatism ≥2.0 D, toric IOL implantation provided superior long-term visual outcomes and reduced amblyopia rates compared with non-toric monofocal IOL implantation. This supports its consideration as the preferred surgical approach for optimizing visual rehabilitation in this population.

