Outcome after very early treatment of dense congenital unilateral cataract

To evaluate whether very early treatment for congenital unilateral cataract results in better long-term functional outcomes, grating acuity, contrast sensitivity, recognition acuity, and random-dot stereoacuity were evaluated in two groups of children.

Grating acuity and contrast sensitivity data were obtained with standard forced-choice protocols. Stereoacuity data were obtained both in a forced-choice laboratory protocol and by the Randot test.

Immediately after treatment, both the very early (1 to 6 weeks; n = 8) and early (2 to 8 months; n = 6) treatment groups showed a 0.3 log unit grating acuity deficit in the aphakic eye. Grating acuity in the early group showed some improvement with age but reached a plateau of 0.75 logMAR at 18 to 24 months; the very early group showed more improvement and reached a plateau of 0.22 logMAR at 37 to 48 months. At 5 to 8 years of age, aphakic eyes of the very early group had significantly better contrast sensitivity and recognition acuity than the aphakic eyes of the early group. Overall, grating acuity deficits during years 2 through 5 were significantly correlated with contrast sensitivity and recognition acuity outcomes measured at 5 to 8 years of age. No deficits in grating acuity, contrast sensitivity, or recognition acuity were found for phakic fellow eyes in either group. Three children in the very early treatment group (37.5%) were orthotropic and demonstrated gross random-dot stereopsis; one child in the early group was orthotropic but none of these children demonstrated random-dot stereopsis.

These results suggest that treatment initiated at 1 to 6 weeks of age maximizes the opportunity for normal or near-normal visual development of a congenitally cataractous eye with little or no risk to the phakic fellow eye.