The association of strabismus and aphakia in children

Strabismus was present in 40% of patients with cataracts/dislocated lenses at the time of initial diagnosis and continued to present an obstacle to complete rehabilitation with 86% of the congenital patients and 61% of the acquired patients found to have strabismus at their latest post therapy visits. The type of horizontal deviation found at the initial examinations was distributed equally between esotropia and exotropia in the unilateral congenital cataracts patients. However, all of our patients with strabismus and bilateral congenital cataracts were esotropic. The acquired group was heavily weighted toward the exodeviations at the time of the initial examination and during treatment showed an even greater percentage of exotropia. Visual acuity results in the various groups followed perhaps the expected trends with the poorest results in the unilateral congenital cataract patients. Those patients in the acquired groups have better visual results with 56% of the traumatic and 83% of the non-traumatic eyes achieving vision of 20/70 or better. Despite the high incidence of strabismus present in these patients, we feel this should in no way be a deterent to the decision to initiate therapy as it does not seem to relate to visual acuity results. The overall good visual results in these patients justifies the approach of early surgery, adequate correction, and vigorous occlusion.