Strabismus Accompanying Pediatric Cataracts and the Effect of Cataract Surgery on Strabismus

To examine the characteristics of preoperative strabismus, the impact of surgical treatment on existing strabismus, and the features of strabismus developing postoperatively in pediatric cataract patients.

The records of patients who underwent surgery for pediatric cataract and had at least 1 year of follow-up were reviewed. Preoperative strabismus types, changes in strabismus after surgery, and the characteristics of postoperative new-onset strabismus were examined.

Seventy-seven pediatric cataract surgery patients were evaluated, 58 (75.3%) with congenital cataract and 19 (24.7%) with acquired cataract. The mean follow-up duration was 63 months (range: 13-185 months). Cataracts were bilateral in 39 patients and unilateral in 38 patients. Strabismus was present preoperatively in 21% of unilateral cases and 20.5% of bilateral cases. In unilateral cases, 50% had esotropia (ET) and 50% had exotropia, while in bilateral cases, these rates were 75% and 25%, respectively. Orthotropia was achieved postoperatively for at least for 1 year of follow-up in 25% of patients with preoperative deviation, all of whom had ET. Twenty-nine (47.5%) of 61 patients who had no deviation preoperatively developed strabismus postoperatively. The rate of new-onset postoperative strabismus in patients with unilateral cataract was 91.6% for those operated before 1 year of age and 38.5% in those operated after the age of 1 year (p=0.001). For bilateral cases, these rates were 50% and 22.2%, respectively (p=0.155).

Strabismus development is commonly observed in pediatric cataracts. While preoperative strabismus may resolve after surgery, postoperative rates remain high, especially in unilateral cases operated before 1 year of age. When managing pediatric cataracts, it is important to carefully evaluate not only for deprivation amblyopia but also strabismic amblyopia. Long-term systematic follow-up after cataract surgery is essential for optimal visual outcomes.