Long-term functional outcomes after congenital cataract extraction with intraocular lens implantation in children of the first year of life

Abstract

To study best corrected visual acuity (BCVA) and identify its relationship with various factors in eyes with pseudophakia in long-term periods after removal of congenital cataract (CC) in the first year of life. The study included 54 children (72 eyes) aged 4 to 12 years who had undergone CC removal with intraocular lens (IOL) implantation at the age of 2-11 months. Examination included: visual acuity testing, Flicker ERG 30 Hz electroretinography (MBN, Russia), optical coherence tomography (HRT-OCT) on the Heidelberg Spectralis (Heidelberg Engineering, Germany) platform. The best results were obtained after removal of bilateral congenital cataract (BCC): BCVA in 58.0% of cases was 0.15-0.3, and in 12.0% of cases - 0.4-0.8. BCVA was 0.1 or less in 95.5% of cases and only one child had 0.2 after removal of unilateral congenital cataract (UCC). The best BCVA was achieved in children operated on the 2-5 month of age (BCVA more than 0.3 in 68.7%; only children from that group had 0.5-0.8), without any concomitant pathology and with normal indicators of ERG Flicker 30 Hz. Deviations from physiological formation of the macula were revealed using OCT. The direct relationship was shown between BCVA, and the maximal retinal thickness in parafovea and choroidal thickness in the subfoveal area. BCVA significantly varies after CC removal with IOL implantation in infancy: 0.02-0.8. The main factors influencing BCVA in that case are: laterality of cataract, child age at the time of operation, duration of visual deprivation, concomitant eye pathology and refractive amblyopia accompanying incomplete correction of aphakia.