Ten-year outcomes of congenital cataract surgery performed within the first six months of life

Abstract

Purpose: In the spectrum of pediatric cataract, genuine congenital cataract poses challenges and has a poorer prognosis than developmental cataract. We investigated the long-term outcomes of congenital cataract surgery performed within the first 6 months of life. Setting: Eleven ophthalmic surgical sites in Japan. Methods: Medical charts were retrospectively reviewed for 216 eyes of 121 patients. The age at surgery was 2.9 ± 1.7 months, with follow-up duration 13.0 ± 2.3 years. The cohort consisted of 83 cases with bilateral aphakia, 12 with bilateral pseudophakia, 20 with unilateral aphakia, and 6 with unilateral pseudophakia. Results: Surgical intervention within the critical period of visual system development (10 weeks for bilateral and 6 weeks for unilateral cases) led to significantly better final visual acuity than surgery conducted after this timeframe. The incidence of secondary glaucoma was similar between groups, while the occurrence of visual axis opacification was more frequent with earlier surgery. A forward stepwise multiple regression analysis revealed that the final visual acuity was significantly associated with laterality of cataract (better outcomes in bilateral cases), phakic status (with pseudophakia outperforming aphakia), presence of systemic and ocular comorbidities, and development of secondary glaucoma. Secondary glaucoma was significantly more prevalent in aphakic eyes than pseudophakic eyes. Conclusions: In patients with genuine congenital cataract, surgery within the critical period of visual development results in better final visual acuity, albeit with an increased risk of visual axis opacification. The use of intraocular lens with sophisticated surgical techniques shows promise even in congenital cataract surgery.