Long-Term Visual Acuity in Young Children After Lensectomy for Congenital Cataract

(1) Background: Congenital cataract is a rare but severe childhood ocular disorder that can lead to permanent visual impairment if left untreated. Factors influencing long-term visual outcomes are insufficiently defined. The aim of this study was to evaluate long-term visual outcomes after congenital cataract surgery and to identify factors associated with visual acuity impairment and reoperation rates. (2) Methods: This retrospective cohort study included 173 eyes of 116 patients who underwent surgery for congenital cataract at the University Hospital Essen between 2000 and 2018. Patients with a minimum postoperative follow-up of six years were included. Best-corrected visual acuity (BCVA) was analyzed according to binocular condition, age at surgery and the presence of comorbidities. Postoperative complications and the need for additional surgical interventions were evaluated. (3) Results: Unilateral cataract was present in 48% (n = 56) and bilateral cataract in 52% (n = 60) of patients. Age at surgery ranged from 2.1 weeks to 15.6 years in unilateral cases and from 3.1 weeks to 8.7 years in bilateral cases. Six years after surgery, mean BCVA was 1.0 logMAR (Snellen 20/200) in unilateral cases and 0.4 logMAR (Snellen 20/50) in bilateral cases. No significant association was found between long-term BCVA and either age at surgery or ocular or systemic comorbidities. Patients with microphthalmia and those born prematurely showed significantly higher rates of additional surgical procedures. (4) Conclusions: Bilateral cases of congenital cataract achieved a significantly better visual acuity than unilateral cases after surgery. In this cohort, neither age at surgery nor the presence of comorbidities was significantly associated with visual acuity, whereas microphthalmia and prematurity were linked to an increased likelihood of additional surgical interventions.