Refractive changes after cataract removal in infancy: comparing eyes with and without persistent fetal vasculature

To evaluate the refractive changes after congenital cataract surgery in persistent fetal vasculature (PFV) vs. non-PFV eyes.

Retrospective study of 75 eyes with PFV or non-PFV congenital cataract, who underwent surgery before age 7 months (unilateral/first operated eye), during 2007-2018 at a tertiary referral center, with follow-up ≥ one-year.

27 eyes (36%) had PFV, 48 were non-PFV cataracts. Mean age (± SD) at surgery in children with PFV was 2.24 ± 1.23 months and 2.44 ± 1.51 months in the non-PFV group. Mean post-operative follow-up was 64.94 ± 34.67 months. 60% of the eyes remained aphakic for the entire follow-up. In aphakic children, the mean post-operative spherical equivalent (SE) in the PFV eye was + 18.74D, + 15.73D, + 13.88D, + 12.51D, + 11.29D at one-month, one-year, two-years, three-years and five-years respectively. In the non-PFV eye the SE was + 23.00D, + 20.44D, + 17.84D, + 17.52D, + 18.48D at one-month, one-year, two-years, three-years and five-years respectively. During the entire post-operative course, the SE remained less hyperopic in the PFV eyes (p < 0.01). The rate of emmetropization was similar for PFV and non-PFV eyes. Five-years after surgery the mean myopic shift was -6.82 ± 4.32 D in the PFV eyes and -5.47 ± 2.44D in the non-PFV eyes (p > 0.05). The changes in refraction error did not correlate with either presence of glaucoma, secondary cataract, amblyopia or strabismus.

Eyes with PFV have a similar rate of emmetropization as other pediatric congenital cataracts. Interestingly, aphakic PFV eyes have a less hyperopic refraction during one-month and up to five-years after surgery as compared to non-PFV eyes.