Clinical Profile and Outcomes of Congenital Cataracts at a Reference Center in Mexico

Abstract

Background: Congenital cataracts are the most common cause of preventable childhood blindness in the world. Treatment of congenital cataracts is among the most difficult and cost-effective interventions in ophthalmology. Our aim was to review a large cohort of patients under a 10-year period to gain a better understanding of multiple factors that influence the outcome of congenital cataracts. Methods: Retrospective review of medical charts of all children with diagnosis of cataract between January 2009 and December 2019 conducted at Ophthalmology Institute “Conde de Valenciana”', Mexico City. Exclusion criteria were children with traumatic or metabolic cataracts, cataracts secondary to uveitis, cataracts associated with previous intraocular surgery or steroid use and patients with no surgical or follow up records. All patients underwent simple aspiration of lens material with coaxial irrigation-aspiration system. In some patients, additional anterior vitrectomy and posterior capsulorhexis was performed. In older children (usually > 3 months of age) an IOL was implanted. Results: A total of 198 eyes of 132 children were analyzed. Median age at presentation was 5.09 years, SE +/- 4.48 years. It was found that the most common cause of congenital cataract was idiopathic 81.81% (N=108), the remaining 18.18% (N=24) was associated with some systemic disease. It was found a 3.5 higher risk of having bilateral cataracts if a systemic disease was present (p=0.01). The most frequent type of congenital cataract was nuclear in 30.1% (N=59), followed by total in 24.5% (N=48) and posterior polar in 14.3 (N=28). A 1.51 higher risk of presenting visual acuity worse than 1.00 LogMar (p=0.011) was found when the form of presentation was total cataracts. 100% of the patients underwent surgery. Only 7.5% (N=15) of the patients required a second surgical intervention. The initial surgical technique was not directly correlated to the requirement for a second surgery (Odds Ratio 0.097, p=0.356). Conclusion: We present our approach to congenital cataracts; these findings provide suggestions for etiology and epidemiology of congenital cataracts and the factors that influence patient visual prognosis.