Amblyopia in the phakic eye after unilateral congenital cataract extraction

The treatment of unilateral congenital cataract remains a challenge because form deprivation early in life leads to amblyopia. Visual outcomes after congenital cataract extraction have improved dramatically with earlier surgery, greater attention to optical correction of the aphakia, and part-time occlusion therapy of the phakic eye. A published review of unilateral congenital cataract studies between 1988 and 2004 found that 88% of patients with primary intraocular lens implantation achieved 20/200 or better visual acuity and a mean of 20% achieved 20/40 or better visual acuity. Improved outcomes are attributable, in part, to surgical intervention at an earlier age. It has been shown that surgical intervention during the first 6 weeks of age is associated with a better visual prognosis than surgery at a later age. In this report, we describe a patient with unilateral congenital cataract treated with cataract extraction and intraocular lens implantation at 8 weeks of age who had a better visual outcome in his operative eye than in his phakic eye.