Long-Term Visual Function Outcomes of Congenital Cataract Surgery with Intraocular Lens Implantation in Children under 5 Years of Age

PURPOSE: To evaluate the long-term visual function outcomes of intraocular lens (IOL) implantation after congenital cataract surgery in children. METHODS: Forty children who had congenital cataract surgery with IOL implantation and at least 5 years follow-up and were 5 years or younger at the time of surgery were included. There were 18 children in the bilateral cataract group (36 pseudophakic eyes) and 22 children in the unilateral cataract group (22 pseudophakic eyes). The examination for the prospective part of this study included the recording of visual acuity, refraction, stereopsis, and intraocular pressures; preoperative, intraoperative, and postoperative details were obtained from the notes. RESULTS: Mean final best-corrected visual acuity for the bilateral group was 0.57 logMAR (range 0.18 -1.06) and for the unilateral group 0.91 logMAR (range 0.18 -1.40). Nystagmus was recorded in 10 children (56%) of the bilateral group and 5 children (23%) of the unilateral group. Strabismus was recorded in 14 children (78%) of the bilateral group and 19 children (86%) of the unilateral group. Glaucoma was diagnosed in one child. There was a significant myopic shift in the unilateral group. CONCLUSIONS: Reasonably good postoperative visual acuity was achieved in the bilateral cataracts group, but relatively poor acuity in the unilateral cataract group. Poor stereopsis was recorded in both groups. One child developed glaucoma. None of the children developed retinal detachment. The expected myopic shift in the unilateral group compared with the bilateral group was demonstrated. Elective primary capsulotomy and elective anterior vitrectomy are mandatory to keep a clear visual axis.