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Outcome after treatment of congenital unilateral cataract
Anna Lundvall1, Ulla Kugelberg
1Department of Paediatric Opthalmology, St Erik's Eye Hospital/Karolinska Institute, Stockholm, Sweden. anna.lundvall@sankterik.se
Insights
Early cataract surgery before 3 months and consistent occlusion therapy are crucial for good visual acuity in children. However, complications like glaucoma are a risk, especially with very early surgery.
Area of Science:
- Ophthalmology
- Pediatric Medicine
- Surgical Outcomes
Background:
- Congenital unilateral cataract requires timely intervention for optimal visual development.
- Long-term outcomes of early surgical management remain a critical area of study.
Purpose of the Study:
- To assess the long-term functional visual outcomes in children treated for congenital unilateral cataract.
- To identify factors influencing visual acuity and complications post-surgery.
Main Methods:
- Retrospective review of 30 children operated on before 12 months of age.
- Follow-up until 4-9.5 years, evaluating visual acuity, occlusion therapy compliance, and ocular complications.
Main Results:
- Good visual acuity (0.1 or better) achieved in 6 children, all operated on before 3 months.
- Four of 12 infants operated on within 6 weeks developed severe secondary glaucoma.
- High rate of occlusion therapy abandonment (21/30) before age 2.5 years.
Conclusions:
- Early surgery (before 3 months) and adherence to occlusion therapy are key for successful visual outcomes.
- Significant risk of severe secondary glaucoma in infants operated on within the first 6 weeks.
- Achieving full compliance with occlusion therapy presents a considerable challenge.
Purpose:
To evaluate long-term functional outcome after treatment of congenital unilateral cataract.
Methods:
The records of 30 consecutive children operated on before the age of 12 months at St. Erik's Eye Hospital over a 5-year period (1991-96) were reviewed retrospectively. The patients were followed until 4-9.5 years of age. Linear Snellen visual acuity (VA), occlusion therapy compliance, and the presence of nystagmus, strabismus and other complications are reported.
Results:
Six children achieved VA of 0.1 or better. They were all operated on before 3 months of age. Of the 12 infants operated on before 6 weeks of age, four have VA between 0.3 and 0.4 and eight have VA of finger counting or less. Four developed severe secondary glaucoma within 6 months of cataract extraction. Two of these had persistent fetal vasculature. Three eyes developing glaucoma became amaurotic. Occlusion therapy was abandoned before the age of 2.5 years in 21 children.
Conclusion:
Good levels of VA were achieved only in children who underwent cataract surgery before 3 months of age and who adhered to the occlusion therapy schedule. Severe secondary glaucoma developed in four out of 12 children operated on within 6 weeks. Full compliance with the occlusion therapy programme was uncommon.