Visual Outcome after Congenital Cataract Surgery. Long-term Clinical Results

The results of congenital cataract extraction were evaluated in 108 patients (163 eyes) who underwent cataract surgery at the Department of Paediatric Opthalmology between 1985 and 1998. The outcome was assessed in terms of postoperative visual acuity and binocular vision. Fifty-one percent of the patients with bilateral aphakia and 47% with bilateral intraocular lens (IOL) implantation had a Snellen visual acuity of 0.5 or higher on the last visit. Similar values were achieved in 36% and 61% of the patients with unilateral aphakia and IOL implantation, respectively. In the patients who wore contact lenses after surgery, 29 % of those with bilateral cataract and 18 % of those with unilateral cataract attained fusion or stereopsis. Eleven of the 17 patients with unilateral cataract who had primary IOL implantation by 6 months of age achieved stereopsis. We conclude that surgery and optical correction should be performed at a very early age, i.e., in the sensitive period of binocular visual development, especially if dense opacities are present. With late surgery, good outcomes are achieved in the eyes in which opacity is only partial or is low in density. The importance of consistent visual rehabilitation and occlusion therapy of the involved eye for the treatment of amblyopia is emphasised.