Cloudy lenses and issues: a pedigree of unoperated congenital cataracts

The issue of when congenital cataracts should be removed seems to be well resolved, with most recommendations stating that all significant central lens opacities should be removed by 4 months of age, with removal most commonly occurring the first month. Although there are many strong recommendations regarding congenital cataracts in the literature, little has been written about the initial decision of whether or not to operate. A pedigree is presented of multiple generations with inherited bilateral central cataracts. Two affected children, who did not undergo surgery, were followed from birth. These two children developed essentially normal vision, despite seemingly significant central opacities. This pedigree emphasizes the need to further examine prognostic factors regarding bilateral infantile cataracts and to analyze the initial surgical decision. Because this condition does not often occur and a large number of patients is necessary to determine the predictive value, a large, collaborative study is required to make significant headway in this area. If we can identify the factors that have strong predictive value for good vision after cataract surgery, we may start to define the profile of children who will have good vision, with or without surgery.