Management of monocular congenital cataracts

From 1971 through 1985, a diagnosis of monocular congenital cataract was made in 14 consecutive patients. All patients had a visually significant cataract that was documented at birth or within 2 months of age. All patients were followed up long enough to report distance linear recognition acuity. Excellent visual acuity (V/A) correlated with earlier surgery, earlier contact lens fit, and excellent amblyopia therapy compliance. The oldest age for attainment of excellent or good V/A was 17 weeks. Patching therapy was based on the binocular fixation pattern. The patching program consisted of 50% occlusion until the age of 2 months and gradually increased to 100% occlusion after the age of 7 months. Six patients (43%) attained excellent V/A (greater than 20/50), with three patients (21%) attaining good V/A (20/60 to 20/100) and five patients attaining poor V/A (less than 20/100).