Unilateral Congenital Cataract Surgery Research Articles

Visual Results Following Surgery for Unilateral Congenital Cataract at a Tertiary Public Hospital in Maharashtra

Purpose: This study aimed to assess the visual outcomes of unilateral congenital cataract surgery in children.  Methods: A total of 204 eyes from 204 children, aged 2 to 12 months, undergoing unilateral congenital cataract surgery between December 2022 and March 2024, were included. The study analyzed data from a three-year follow-up and used chi-square tests to assess the relationship between visual outcomes and the age at surgery, considering P < 0.05 as statistically significant.  Results: Of 204 eyes, 64 (31.4%) underwent surgery at 2-3 months and 140 (68.6%) at 3-12 months. Visual acuity was measured postoperatively, revealing significantly poorer outcomes in children aged 3 months or older (P < 0.001) compared to those aged 2-3 months.  Conclusions: It is essential to detect and treat congenital cataracts early, followed by long-term postoperative rehabilitation, to improve visual outcomes in affected children, particularly in cases of unilateral cataract, which are more prone to developing amblyopia.

Analysis of age at detection and outcomes of dense unilateral congenital cataract surgery for children on the paediatric cataract register.

Analysis of age at time of detection and surgery of dense unilateral cataract and investigation of best-corrected visual acuity (BCVA) in a nationwide register-based cohort study, based on the routine of maternity ward eye screening. Data were derived from the Paediatric Cataract Register (PECARE). All children (n= 54) diagnosed with dense congenital unilateral cataract between January 2007 and September 2014 who had surgery before 1 year of age, and for whom 5-year follow-up records were available, were included. The majority, 35/54 (65%), were detected and operated on before age 6 weeks and 30/35 (86%) were referred from maternity wards. Visual acuity (VA) ≥ 0.5 (decimal, 0.3 logMAR) was found in 7/53 (13%) of the cohort at age 5 years; further, 19 children achieved VA ≥ 0.1 (decimal, 1.0 logMAR) (36%) and 19 children VA < 0.05 (decimal, 1.30 logMAR) (36%). Ten-year follow-up records were available for 17/53 (32%) children; 1/17 (6%) achieved VA ≥ 0.5 (decimal, 0.3 logMAR), 4/17 (24%) VA ≥ 0.3-<0.5 (decimal, 0.52-0.30 logMAR), 3/17 (18%) VA ≥ 0.05-0.1 (decimal, 1.30-1.0 logMAR) and 10/17 (59%) VA < 0.05 (decimal, 1.30 logMAR). A total of 90% of the children were detected with cataract within 100 days of birth and 80% were operated on within this period. This study showed better visual acuity in those treated for dense unilateral cataracts than previously reported in an earlier Swedish cohort study.

A Case Report of Unilateral Pediatric Cataract Surgery: Posterior Capsule Opacification and Visual Rehabilitation

Objective: To report a case of posterior capsule opacification (PCO) and severe deprivation amblyopia following unilateral pediatric cataract surgery Case Presentation: A 4-year-old girl presented with PCO of the right eye with a history of unilateral congenital cataract surgery and intraocular lens (IOL) implantation without optimal visual rehabilitation two years ago at another hospital in Jakarta. Her uncorrected right eye visual acuity was 3/60 and corrected left eye visual acuity 6/7.5. We performed secondary posterior capsulotomy and anterior vitrectomy of the right eye. Following the procedure, the patient did not regain her vision despite normal posterior segment; thus, a diagnosis of deprivation amblyopia was made. She was prescribed occlusion therapy for 6 hours a day on the left eye to decrease the degree of amblyopia of her right eye. Conclusion: Early identification and management of pediatric cataract surgery complications combined with optimal visual rehabilitation may benefit the patient in the long run. If not treated properly, especially in unilateral cataract cases, it may be too late to regain visual function.

The role of primary intraocular lens implantation in the risk of secondary glaucoma following congenital cataract surgery: A systematic review and meta-analysis.

ObjectiveThis meta-analysis aims to evaluate the incidence of secondary glaucoma in patients under the age of 2 years who underwent congenital cataract surgery with or without primary intraocular lens (IOL) implantation.MethodsAn electronic literature search was performed in Medline, EMBASE, and Web of Science databases to retrieve studies between January 2011 and November 2018. Patients with congenital cataract who did primary IOL implantation, aphakia, or secondary IOL implantation followed by receiving extraction surgery were included in this study. Relevant studies meeting defined eligibility criteria were selected and reviewed systematically by meta-analysis. Long-term incidences of secondary glaucoma, which developed at least one year after cataract surgery, were considered and discussed as clinical outcomes in each cohort. The pooled data were analyzed according to a random effects model.ResultsEight publications involving 892 eyes were included in the current meta-analysis. In the general population of eyes with congenital cataract, the long-term incidence of secondary glaucoma was lower (P = 0.06) in eyes with primary IOL (9.5%) than in eyes without primary IOL (15.1%), including aphakia and secondary IOL. The pooled risk ratio (RR) favors primary IOL implantation in all patients (RR = 0.63). For bilateral congenital cataract, the incidence was 6.7% in eyes with primary IOL implantation, which is significantly lower than the 16.7% in eyes with aphakia and secondary IOL implantation (P<0.05, RR = 0.44). However, for unilateral congenital cataract surgery, the incidence was very similar in eyes with and without primary IOL (12.4% vs 12.0%, P = 0.61, RR = 0.87).ConclusionsIn patients under 2 years of age, primary IOL implantation for bilateral congenital cataract surgery is associated with a lower risk of secondary glaucoma.

Factors associated with stereopsis and a good visual acuity outcome among children in the Infant Aphakia Treatment Study.

PurposeTo identify factors associated with stereopsis in children with good visual acuity after unilateral congenital cataract surgery in the Infant Aphakia Treatment Study.Patients and methodsInfants with a unilateral congenital cataract (n=114) were randomized to IOL implantation or contact lens correction after cataract surgery. At age 4.5 years, a masked examiner assessed HOTV acuity and stereopsis. Adherence to patching was assessed using 48-h recall telephone interviews and 7-day diaries throughout the first 5 years of life. Ocular motility was evaluated at age 5 years. Baseline, postoperative, and adherence findings were compared between patients with 20/40 or better acuity in their treated eyes with or without stereopsis.ResultsThirty (27%) of 112 patients who were evaluated at age 4.5 years had 20/40 or better acuity in their treated eye. Stereopsis was present on one or more tests in 15 of these 30 (50%) children. Baseline characteristics and postoperative findings did not differ between patients with or without stereopsis. Children with stereopsis were more likely to be orthotropic at distance (P=0.003) and were patched for fewer hours per day throughout the first 5 years of life and the difference increased over time (P<0.001). On average children with stereopsis were patched for 3.4 h/day during the first year of life and patching steadily decreased to 1.8 h/day by age 4 years.ConclusionAmong children with good vision following unilateral congenital cataract surgery, orthophoria and fewer hours of patching, particularly during years 2, 3, and 4, are associated with some evidence of stereopsis.

Primary versus secondary IOL implantation following removal of infantile unilateral congenital cataract: outcomes after at least 5 years

To report outcomes after at least 5years' follow-up of consecutive patients at a single center undergoing unilateral congenital cataract surgery during infancy with primary intraocular lens (IOL) implantation at the time of surgery or undergoing secondary IOL implantation later in childhood. The medical records of pseudophakic children who received initial cataract surgery before 7months of age were retrospectively reviewed. Children with acquired cataract, persistent fetal vasculature, congenital glaucoma, or follow-up of <5years were excluded. Mean age at time of cataract surgery was 2.7months in the primary group (n=13) and 1.9months in the secondary group (n=13). Mean age at IOL implantation in the latter group was 4.9±2.2years. Mean age at final follow-up was 10.7±4.2years in the primary group and 8.7±3.0years in the secondary group. Glaucoma surgery was performed in 2 primary group eyes and 1 secondary group eye; it was medically controlled in 2 additional eyes of the latter group. One secondary group eye was diagnosed as glaucoma suspect. Visual axis opacification required surgery in 5 primary group eyes and 2 secondary group eyes before IOL implantation. Unplanned IOL exchange or removal for high myopia was required in 3 primary group eyes and 1 secondary group eye. Strabismus surgery was performed in 3 primary group eyes and 7 secondary group eyes. Median visual acuity at final follow-up was 20/150 in both groups. Refraction at last follow-up was -2.9±3.3 D in the primary and -1.8±2.5 D in the secondary group. Reoperations were common in both groups over long-term follow-up. Close monitoring for glaucoma is also needed in both groups.

Effect of unilateral congenital cataract surgery on ocular axial length growth and corneal flattening

ObjectiveThe aim of this article is to study the effect of unilateral congenital cataract surgery on ocular growth and corneal flattening. MethodsThis is a cross-sectional study of 59 patients operated on due to a unilateral congenital cataract. The median age of the patients at the time of diagnosis was 17 months (interquartile range, 5–39 months). The median age at cataract the time of surgery was 28 months (interquartile range, 8–52 months), and the mean follow-up between cataract surgery and assessments was 149.7±69.9 months (range, 30–319 months). Axial length and corneal curvature were measured in both operated and non-operated eyes, comparing the results between them. ResultsThere were no statistically significant differences for axial length growth or corneal flattening between operated and non-operated eyes: axial length (P=.327, Student t test) and corneal curvature (P=.078, Student t test). A sub-analysis was performed using the visual acuity and the age of the patient at the time of surgery. The only statistically significant data (P=.007, Student t test) was a lower axial length in operated eyes compared to non-operated eyes, in the non-deep-amblyopia group. ConclusionsNo significant axial length growth modifications were observed between operated and non-operated eyes. Only the non-deep-amblyopia group presented with a lower axial length in the operated eyes compared to non-operated eyes. No significant differences in corneal flattening were found between groups after unilateral congenital cataract surgery.

Efecto de la cirugía de las cataratas congénitas unilaterales sobre el crecimiento ocular axial y el aplanamiento corneal

ObjectiveThe aim of this article is to study the effect of unilateral congenital cataract surgery on ocular growth and corneal flattening. MethodsThis is a cross-sectional study of 59 patients operated on due to a unilateral congenital cataract. The median age of the patients at the time of diagnosis was 17 months (interquartile range, 5-39 months). The median age at cataract the time of surgery was 28 months (interquartile range, 8-52 months), and the mean follow-up between cataract surgery and assessments was 149.7±69.9 months (range, 30-319 months). Axial length and corneal curvature were measured in both operated and non-operated eyes, comparing the results between them. ResultsThere were no statistically significant differences for axial length growth or corneal flattening between operated and non-operated eyes: axial length (P=.327, Student t test) and corneal curvature (P=.078, Student t test). A sub-analysis was performed using the visual acuity and the age of the patient at the time of surgery. The only statistically significant data (P=.007, Student t test) was a lower axial length in operated eyes compared to non-operated eyes, in the non-deep-amblyopia group. ConclusionsNo significant axial length growth modifications were observed between operated and non-operated eyes. Only the non-deep-amblyopia group presented with a lower axial length in the operated eyes compared to non-operated eyes. No significant differences in corneal flattening were found between groups after unilateral congenital cataract surgery.

Cost of Intraocular Lens versus Contact Lens Treatment after Unilateral Congenital Cataract Surgery in the Infant Aphakia Treatment Study at Age 5 Years

To analyze differences in the cost of treatment for infants randomized to primary intraocular lens (IOL) implantation versus optical correction with a contact lens (CL) after unilateral cataract surgery in the Infant Aphakia Treatment Study (IATS). Retrospective cost analysis of a prospective, randomized clinical trial based on Georgia Medicaid reimbursement data as well as actual costs of supplies used during the study, adjusted for inflation. The IATS is a multicenter (n= 12), randomized clinical trial comparing the optical treatment of aphakia with either primary IOL implantation (n= 57) or CL correction (n= 57) in 114 infants with unilateral congenital cataract. One hundred fourteen infants underwent unilateral cataract surgery and were either corrected optically by primary IOL implantation at the time of surgery or were corrected with a CL after surgery. The mean cost of cataract surgery and all additional surgeries, examinations, and supplies used up to 5 years of age. The 5-year treatment cost of an infant with a unilateral congenital cataract corrected optically with an IOL was $27 090 versus $25 331 for a patient treated with a CL after initial cataract surgery. The total cost of supplies was $3204 in the IOL group versus $7728 in the CL group. Unilateral cataract surgery in infancy coupled with primary IOL implantation is approximately 7% more expensive than aphakia and CL correction. Patient costs are more than double with CL versus IOL treatment.

Stereopsis Results at 4.5 Years of Age in the Infant Aphakia Treatment Study

To determine whether stereopsis of infants treated for monocular cataracts varies with the type of optical correction used. Randomized prospective clinical trial. The Infant Aphakia Treatment Study randomized 114 patients with unilateral cataracts at age 1-7 months to either primary intraocular lens (IOL) or contact lens correction. At 4.5 years of age a masked examiner assessed stereopsis on these patients using 3 different tests: (1) Frisby; (2) Randot Preschool; and (3) Titmus Fly. Twenty-eight patients (25%) had a positive response to at least 1 of the stereopsis tests. There was no statistically significant difference in stereopsis between the 2 treatment groups: Frisby (contact lens, 6 [11%]; IOL, 7 [13%]; P = .99), Randot (contact lens, 3 [6%]; IOL, 1 [2%]; P = .62), or Titmus (contact lens, 8 [15%]; IOL, 13 [23%]; P = .34). The median age at surgery for patients with stereopsis was younger than for those without stereopsis (1.2 vs 2.4 months; P = .002). The median visual acuity for patients with stereopsis was better than for those without stereopsis (20/40 vs 20/252; P = .0003). The type of optical correction did not influence stereopsis outcomes. However, 2 other factors did: age at surgery and visual acuity in the treated eye at age 4.5 years. Early surgery for unilateral congenital cataract and the presence of visual acuity better than or equal to 20/40 appear to be more important than the type of initial optical correction used for the development of stereopsis.

Cost of Intraocular Lens versus Contact Lens Treatment after Unilateral Congenital Cataract Surgery: Retrospective Analysis at Age 1 Year

To describe the differences in treatment costs for infants randomized to contact lens correction versus primary intraocular lens (IOL) implantation after unilateral cataract surgery in the Infant Aphakia Treatment Study (IATS). Retrospective cost analysis of a prospective, randomized clinical trial based on Georgia Medicaid data and the actual costs of supplies used. The IATS is a randomized, multicenter (n=12) clinical trial comparing treatment of aphakia with a primary IOL or contact lens in 114 infants with unilateral congenital cataract. Infants underwent cataract surgery with or without placement of an IOL. The mean cost of cataract surgery and all additional surgeries, examinations, and supplies used up to 12 months of age. The mean cost of treatment for a unilateral congenital cataract with primary IOL implantation was $14 752 versus $10 726 with contact lens correction. The initial cataract surgery accounted for approximately 50% of the treatment costs for both groups. Contact lens costs accounted for 15% ($1600/patient) in the aphakic group, whereas glasses costs represented only 4% ($535/patient) in the IOL group. The increased costs in the IOL group were primarily due to the higher cost of cataract surgery in this group ($7302 vs. $5357) and the cost of additional operations. For IATS patients up to 12 months of age, cataract surgery coupled with IOL implantation and spectacle correction was 37.5% (∼$4000) more expensive than cataract surgery coupled with contact lens correction. The author(s) have no proprietary or commercial interest in any materials discussed in this article.

Advances in the management of congenital and infantile cataract

Congenital and infantile cataracts produce deprivation amblyopia and can thus cause lifelong visual impairment. Successful management is dependent on early diagnosis and referral for surgery when indicated. Accurate optical rehabilitation and postoperative supervision are essential.The timing of surgery and its relationship to the duration of deprivation is important. Unilateral congenital cataract surgery within 6 weeks of birth produces the best outcomes. The equivalent 'latent' period for bilateral visual deprivation may be longer at around 10 weeks. Visual deprivation has a significant impact on the development of fixation stability. Major form deprivation, even after early surgery, leads to nystagmus. This is mostly manifest latent nystagmus (MLN). The latent period for fixation stability may be as short as 3 weeks. Preoperative congenital nystagmus (CN) can convert to more benign MLN after surgery. Infantile IOL implantation is becoming increasingly accepted. A satisfactory long-term refractive result requires that allowance be made for childhood axial growth and myopic shift. In a series of 25 infants (33 eyes) implanted before 12 months of age, the mean myopic shift at 12 months was 4.83 D. This increased to 5.3 D in infants implanted before 10 weeks. The initial desired refractive outcome following IOL implantation is thus hypermetropia, with the degree dependent on the age of the child. Glaucoma or ocular hypertension is a common complication following paediatric cataract surgery. Microphthalmia and surgery in early infancy are risk factors. Tonometry results may be influenced by the increased corneal thickness seen in aphakic and pseudophakic children. The long-term prognosis of eyes with aphakic glaucoma is not necessarily poor but intraocular pressure control may require three or more medications. Surgical intervention appears to be necessary in over a quarter of eyes. Posterior capsule opacification (PCO) is common in infants undergoing primary lens implantation. Primary capsulotomy and anterior vitrectomy reduce the risk of PCO. In the absence of anterior vitrectomy, primary posterior capsulotomy does not prevent visual axis opacification. Further developments will continue to be driven by clinical research. The prevention of capsule opacification and cellular proliferation may in future be achieved by the use of devices to specifically target epithelial cells at surgery.

Visual Results after Primary Intraocular Lens Implantation or Contact Lens Correction for Aphakia in the First Year of Age

Purpose: The optimal role of intraocular lenses (IOLs) in infants remains a controversial topic. Some ophthalmologists advocate correction with a contact lens (CL), whereas others recommend an IOL correction. Our study compared visual acuity, ocular alignment, retreatment rate and binocular vision outcomes in children treated with these two methods at our clinic. Methods: This study included 41 children with unilateral congenital cataract who underwent cataract surgery with posterior capsulorhexis and anterior vitrectomy, coupled with (IOL group, n = 18) or without (CL group, n = 23) primary IOL implantation. All infants underwent the first surgery during the first 12 months of their life and they were operated on in the period from 1994 to 1999. The mean age at surgery was 3.11 ± 2.65 months (range: 28 days to 11 months). All patients were prescribed the same half-time reduced occlusion therapy. Good cooperation of the parents and good compliance with patching were the necessary conditions to include a patient in the study. Between January and February 2003, the final visual acuity and binocular vision outcomes were examined. Results: The mean final visual acuity (logarithm of the minimum angle of resolution) of the operated eye was 0.43 ± 0.33 for the IOL group and 0.58 ± 0.39 for the CL group (p = 0.14). The mean interocular difference in visual acuity was 0.22 ± 0.29 for the IOL group and 0.56 ± 0.31 for the CL group (p = 0.042). The reoperation rate was 78% in the IOL group compared with 35% in the CL group (p = 0.017). Esotropia or exotropia of more than 8 prism diopters were present in 55% of children (10/18) in the IOL group compared with 83% of children (19/23) in the CL group (p = 0.039). Conclusions: We suggest that correction of aphakia after unilateral congenital cataract surgery with primary IOL implantation results in improved visual acuity, improved binocular vision outcome and less occurrence of strabismus, but a higher rate of complications requiring reoperation. Further studies with a larger pediatric patient group are necessary to confirm the optimal treatment of aphakia after unilateral congenital cataract extraction.

A comparison of grating visual acuity, strabismus, and reoperation outcomes among children with aphakia and pseudophakia after unilateral cataract surgery during the first six months of life

Purpose: The method of correcting aphakia after unilateral cataract extraction during infancy is controversial. Some authorities advocate correction with an intraocular lens (IOL) whereas others advocate correction with a contact lens (CL). We compared grating visual acuity, alignment, and reoperative outcomes in age-matched children treated with these 2 modalities at 5 clinical centers. Methods: Twenty-five infants born in 1997 or 1998 with a dense unilateral congenital cataract who had cataract surgery coupled with (IOL group, n = 12) or without (CL group, n = 13) primary IOL implantation were enrolled in this study. All patients were prescribed half-time occlusion therapy. In July 1999, their grating visual acuities, ocular alignments, and reoperation rates were assessed. Results: The mean grating visual acuity (LogMAR) for the affected eye was 0.70 ± 0.32 for the IOL group and 0.87 ± 0.31 for the CL group (P = .19). The mean interocular difference in grating visual acuity was 0.26 ± 0.30 for the IOL group and 0.50 ± 0.28 for the CL group (P = .048). The incidence of strabismus (>10 PD) was 75% in the IOL group compared with 92% in the CL group (P = .24). The incidence of reoperations was 83% in the IOL group compared with 23% in the CL group (P = .003). Conclusions: Our preliminary data suggest that correcting aphakia after unilateral congenital cataract surgery with primary IOL implantation results in an improved visual outcome but a higher rate of complications requiring reoperation. A randomized clinical trial, the Infant Aphakia Treatment Study, is planned to further study the optimal treatment for aphakia following unilateral cataract extraction during infancy. (J AAPOS 2001;5:70-5)

Visual Function following Unilateral Congenital Cataract Surgery

Purpose:The aim of this study was to evaluate the factors related to the postoperative visual prognosis in unilateral congenital cataracts.Methods:Pars plana lensectomy and anterior vitrectomy was carried out in 18 children with unilateral congenital cataract. All children received hard contact lens correction and occlusion therapy after surgery. Postoperative visual function was assessed by Landolt visual acuity (V/A) and Titmus® Stereo Tests.Results:Four patients in the good acuity group achieved a V/A of 1.0 and 14 patients in the poor acuity group had V/A ranging from 0.02 to 0.4. Age at surgery significantly related to the postoperative V/A in the poor group but not in patients with good acuity.Conclusion:We found that poor visual prognosis correlated with age at surgery performed after 3 months of age rather than with compliance to visual rehabilitation. Good visual prognosis in congenital cataract with early onset was attributed to very early surgery since a patient who had cataract extraction at 3 weeks of age attained a V/A of 1.0.

Modulation of amblyopia therapy following early surgery for unilateral congenital cataracts.

Stimulus deprivation amblyopia is the principal cause of visual impairment in infants with unilateral congenital cataract. Even if lensectomy is undertaken at an early age, intensive postoperative occlusion of the phakic eye is essential for the development of useful vision in the aphakic eye. Despite this, the optimum method of regulating occlusion therapy is uncertain. Interocular acuity differences identified using clinical preferential looking techniques (Keeler cards) were used to regulate target levels of phakic eye occlusion in a prospective evaluation of 10 systemically, metabolically, and neurologically normal infants in whom dense unilateral cataract was diagnosed before 8 weeks of age, and operated upon by 10 weeks. Actual occlusion levels were recorded each day by parents in a diary. The development of preferential looking acuity in the phakic and aphakic eye were compared with prediction intervals derived from observations on 43 normal children. Aphakic eye preferential looking acuities were within the normal range at last review in all but one infant. Interocular acuity differences were < or = 0.5 octave in all children older than 1 year of age at last review, and > or = 1 octave in three of four children less than 1 year old at last review (Fisher exact p = 0.033). Phakic eye acuities were within the normal range in all infants at all visits. Within the first 2 years of life, normal preferential looking acuity may be achieved in both eyes of infants undergoing early surgery for unilateral congenital cataract if occlusion therapy is modulated according to interocular acuity differences quantified by clinical preferential looking techniques.