Visual Outcome and Related Factors in Bilateral Total Congenital Cataract Patients: A Prospective Cohort Study

Abstract

This study is to evaluate the visual outcome and identify its crucial related factors in children undergoing cataract surgery for bilateral total congenital cataract (CC). This prospective study included consecutive bilateral total cataract patients undergoing primary surgery at Zhongshan Ophthalmic Center (ZOC), Guangzhou, China from Jan 2010 to May 2014. Visual outcome was estimated by best-corrected visual acuity (BCVA) at last follow-up. Potential related factors, including gender, age at last follow-up, age at primary surgery, surgical procedure, postoperative complications (PCs), frequency of follow-up and changes in spectacles were evaluated. Eighty-eight children (176 eyes) were included in the cohort. The mean post-operative BCVA (logMAR) was 1.07 ± 0.53 at the mean follow-up duration 31.07 ± 19.36 months. Multivariable generalized estimating equations (GEEs) showed BCVA was significantly associated with PCs, age at last follow-up and age at primary surgery. Partial correlation analysis indicated age at primary surgery was positively correlated with BCVA controlling for the other factors, both for the whole age range (R = 0.415, P < 0.001) and age >6 months (R = 0.867, P < 0.001). Better visual acuity was related to early primary surgery and low PC occurrence in children with bilateral total CC. Timely surgical intervention and strict control of PCs would be potential steps to achieving better visual outcome.

Figure 1. Flowchart of patient selection.

CC = Congenital cataract; CCPMOH = Childhood Cataract Program of the Chinese Ministry of Health; BCVA = Best-corrected visual acuity.

Figure 2. The distribution of included CC patients with different age periods.

Nearly 85.2% (75/88) of the included CC patients were younger than 1 year old.

Figure 3. Partial correlation analysis of the relationship between age at primary surgery and BCVA (logMAR).

(a) Relationship between all ages at primary surgery and BCVA (n = 176). (b) Relationship between age at primary surgery (>6 months) and BCVA (n = 48). (c) Relationship between age at primary surgery (≤6 months) and BCVA (n = 128). The X-axis represents the residual values of BCVA (logMAR) regressed upon other influencing factors; The Y-axis represents the residual values of age at primary surgery regressed upon other influencing factors. The regression lines were created based on linear regression, and the corresponding amount of variance (R²) was accounted for by the linear relationship.