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. 2025 Nov;132(11):1284-1293.
doi: 10.1016/j.ophtha.2025.06.022. Epub 2025 Jun 27.

Effects of Age at Surgery and Laterality of Cataract on Visual Acuity 5 Years after Surgery in Infants Left Aphakic

Michael X Repka  1 , Desirae R Sutherland  2 , Sarah R Hatt  3 , Bahram Rahmani  4 , David A Leske  3 , Erick D Bothun  3 , Marielle P Young  5 , Mitchell B Strominger  6 , Susanna M Tamkins  7 , Wesley T Beaulieu  2 , Raymond T Kraker  2 , Jonathan M Holmes  8 , Susan A Cotter  9 ; Pediatric Eye Disease Investigator Group
Collaborators, Affiliations

Effects of Age at Surgery and Laterality of Cataract on Visual Acuity 5 Years after Surgery in Infants Left Aphakic

Michael X Repka et al. Ophthalmology. 2025 Nov.

Abstract

Purpose: To evaluate 5-year visual acuity (VA) outcomes by age at surgery and laterality among infants left aphakic at initial lensectomy.

Design: Prospective Pediatric Eye Disease Investigator Group cataract registry.

Participants: A total of 149 infants (203 eyes; 123 with bilateral surgery) underwent surgery before 12 months of age (median, 1.8; range, 0.6-11.6 months) for nontraumatic cataract without preexisting glaucoma or anterior/posterior segment anomalies who were left aphakic.

Methods: Records were reviewed annually for 5 years after surgery. Children were grouped by age at first surgery (<2 months, 2 to <6 months, and 6 to <12 months). Analyses accounted for nonindependence of eye pairs.

Main outcome measures: Mean VA and proportion of eyes with VA better than 20/200.

Results: Eighty-nine (60%) infants were female, 114 infants (77%) were White, 17 infants (11%) were Black, and 21 infants (14%) were Hispanic or Latino. In unilateral cases (N = 80), surgery before 2 months of age was associated with better mean VA at 5 years than with surgery between 2 and <6 months of age (0.79 vs 1.13 logarithm of the minimum angle of resolution [logMAR], difference = 0.34 [95% CI, 0.08-0.59], P = 0.01). In bilateral cases (N = 123), age at surgery was not associated with 5-year VA outcomes (P = 0.18). A larger proportion of bilaterally operated eyes had VA better than 20/200 compared with undergoing unilateral surgery before 2 months (87% vs 61%; difference = 26% [95% CI, 8%-43%]; P = 0.004) and 2 to <6 months of age (95% vs 23%; difference = 72% [95% CI, 55%-90%]; P < 0.001).

Conclusions: For bilateral surgery in the first year of life, 5-year VA did not differ by age at surgery. However, for unilateral cataract, 5-year VA was better with surgery before 2 months of age compared with 2 to <6 months. These observations may inform surgical decision-making when treating a cataract in the first 2 months of life. Given the increased risk for glaucoma with early cataract surgery, the surgeon may choose a modest delay in the timing of surgery, accepting a decrease in the VA outcome for unilateral cases.

Financial disclosure(s): Proprietary or commercial disclosure may be found after the references.

Keywords: Cataract; Cataract Surgery; Pediatric; Registry.

PubMed Disclaimer

Conflict of interest statement

Conflict of Interest: No conflicting relationships exist for any author.

References

    1. Birch EE, Swanson WH, Stager DR, Woody M, Everett M. Outcome after very early treatment of dense congenital unilateral cataract. Invest Ophthalmol Vis Sci. 1993;34(13):3687–99. - PubMed
    1. Birch EE, Cheng C, Stager DR Jr., Weakley DR Jr., Stager DR Sr. The critical period for surgical treatment of dense congenital bilateral cataracts. J AAPOS. Feb 2009;13(1):67–71. doi: 10.1016/j.jaapos.2008.07.010 - DOI - PMC - PubMed
    1. Birch EE, Stager DR. The critical period for surgical treatment of dense congenital unilateral cataract. Invest Ophthalmol Vis Sci. Jul 1996;37(8):1532–8. - PubMed
    1. Gelbart SS, Hoyt CS, Jastrebski G, Marg E. Long-term visual results in bilateral congenital cataracts. Am J Ophthalmol. May 1982;93(5):615–21. doi: 10.1016/s0002-9394(14)77377-5 - DOI - PubMed
    1. Freedman SF, Kraker RT, Repka MX, et al. Incidence and management of glaucoma or glaucoma suspect in the first year after pediatric lensectomy. JAMA Ophthalmol. 2020;138(1):71–75. doi: 10.1001/jamaophthalmol.2019.4571 - DOI - PMC - PubMed

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