ESCRS - PO030 - Implantation Of An Edof Refractive Iol In A Young Patient With Bilateral Congenital Cataract: Considerations For Refractive Stability And Astigmatism Management

Implantation Of An Edof Refractive Iol In A Young Patient With Bilateral Congenital Cataract: Considerations For Refractive Stability And Astigmatism Management

Published 2025 - 43rd Congress of the ESCRS

Reference: PO030 | Type: Case Report | DOI: 10.82333/bef0-7j93

Authors: Rosa Giglio* 1 , Daniele Tognetto 1

1Department of Medical, Surgical Sciences and Health, University of Trieste,University Eye Clinic,Trieste,Italy

Purpose

To report the implantation of a refractive extended depth of focus (EDOF) intraocular lens (IOL) in a young patient with bilateral congenital cataract, focusing on preoperative calculations, astigmatism management, and long-term refractive stability

Setting

University Eye Clinic of Trieste, Trieste, Italy

Report of case

A 14-year-olds patient with bilateral congenital cataract underwent refractive EDOF toric IOL implantation following comprehensive biometric analysis, corneal tomography, and axial length measurements. Given the known challenges in pediatric IOL calculations, multiple formulas—including Pearl DGS, EVO, and Kane—were applied to optimize postoperative refraction while considering potential myopic shift over time.

The preoperative assessment identified with-the-rule (WTR) astigmatism, which is expected to decrease with age and potentially shift towards against-the-rule (ATR) astigmatism. To address this, a low toric power IOL with slight undercorrection was selected to minimize future refractive instability. Surgically induced astigmatism (SIA) was also factored into the calculations to optimize long-term outcomes.

The one-month postoperative evaluation showed satisfactory visual outcomes with a binocular visual acuity of 0.1 LogMAR (8/10 decimal) for distance, 0.2 LogMAR (6/10 decimal) for intermediate vision, and functional near vision, demonstrating the effectiveness of EDOF technology in providing extended functional vision in teenagers cataract cases.

Conclusion/Take home message

EDOF IOLs are a viable option for young patients with congenital cataracts, offering a balance between distance and functional near vision.

Preoperative IOL calculations require multiple formulas and special considerations 

Astigmatism management is critical, as pediatric eyes often experience a shift from WTR to ATR astigmatism over time; undercorrection should be considered to prevent future refractive issues.

Long-term follow-up is essential to monitor changes in refraction and optimize functional vision over time.

This case highlights the importance of careful surgical planning, individualized IOL selection, and long-term refractive considerations in young patients undergoing cataract surgery.