Long-term visual outcome after extraction of unilateral congenital cataracts

Abstract

Background: Congenital cataract significantly impairs visual development. Although treatable, a good visual outcome is difficult to achieve, requiring prompt lensectomy and prolonged visual rehabilitation.

Purpose: The aim of this study was to investigate whether useable visual acuity (VA) is a realistic goal in these patients.

Methods: A retrospective case review from a tertiary referral centre was performed. This study included children with unilateral congenital cataract who underwent cataract surgery with posterior capsulectomy and anterior vitrectomy.

Results: A total of 62 patients were identified. Of them, 32% of aphakic eyes had a final VA of 0.6 LogMAR or better (average 0.34+/-0.17). The average age at the time of surgery was 5.0+/-4.1 weeks. The remaining 68% had vision that was less than 0.6, with 27% having vision of <1.00. The group with vision less than 0.6 (68%) had an average age of 9.7+/-6.5 weeks at the time of surgery. One case (1.6%) achieved a VA of 0.0 and also had demonstrable stereoacuity (110 arc s). Manifest strabismus was present in 85% of cases. Glaucoma developed in 19% of patients and 31% discontinued the occlusion regime before the age of 4 years. In most of these cases, occlusion was ceased by the age of 2 years when testing revealed dense amblyopia in the aphakic eye even if good compliance had previously been achieved. In many cases, this coincided with the child becoming noncompliant with occlusion.

Conclusions: More than two-thirds of children in our cohort did not develop acuity better than 0.6 LogMAR in their aphakic eye.