Clinical symptoms and visual outcome in patients with presumed congenital cataract

To investigate clinical symptoms and visual outcome in patients who had presumed congenital cataract with visual acuity > or =20/200.

Twenty-nine patients (50 eyes) ranging in age from 5-28 years were included in this study. Congenital cataract was diagnosed by patients' past history, previous medical records, and typical findings of congenital cataract. Inclusion criteria were patients with visual acuity measured by Snellen chart, best corrected visual acuity > or =20/200, and no eye or systemic diseases influencing visual acuity. Seven patients had unilateral cataracts and 22 patients had bilateral cataracts. Cataracts were nuclear in 29 eyes, anterior or posterior subcapsular in 12 eyes, and polar in 7 eyes. All patients underwent lens aspiration or phacoemulsification combined with posterior chamber intraocular lens (PC-IOL) implantation without performing intentional posterior capsulotomy and anterior vitrectomy.

The most common clinical symptom was visual disturbance followed by blurred vision, glare and knitting the brow, strabismus, and leukocoria. Comparison of calculated PC-IOL power showed a more significant myopic shift in unilateral cataract than in bilateral cataract. Postoperative best corrected visual acuity >20/25 was attained in 28 (65.1%) eyes with bilateral cataracts and 1 (14.3%) eye with a unilateral cataract.

Cataract surgery is effective not only in improving visual acuity but also in eliminating clinical symptoms. Delaying cataract surgery in early infancy should be considered to avoid intentional operative procedures in patients with bilateral congenital cataract preserving visual acuity >20/200.