Abstract:Background and Objective: Congenital cataract is a primary cause of preventable blindness in children, and prompt surgical surgery is crucial for good visual results. Nonetheless, long-term visual and refractive outcomes may be affected by various factors, including the scheduling of surgery, surgical technique, and postoperative treatment. This study sought to assess the long-term visual acuity and refractive condition in infants under 2 years old who received congenital cataract surgery, with or without intraocular lens (IOL) implantation.
Material and Methods: This retrospective observational study encompassed 40 pediatric patients (56 eyes) who underwent extraction of congenital cataracts. This research was performed at the Department of Ophthalmology, Madha Medical College and Hospital, located on Kundrathur Main Road, Kovur, Thandalam, Tamil Nadu, India, from September 2018 to August 2019. Patients were monitored for a minimum of 24 months following surgery. The collected data encompassed demographic information, cataract type, age at surgery, laterality, visual acuity outcomes, postoperative complications, and refractive errors. Visual outcomes were evaluated utilizing age-appropriate techniques (preferential gazing, Cardiff acuity cards, or Snellen chart based on age at follow-up), and refractive outcomes were documented as spherical equivalent.
Results: Surgery was performed at an average age of 9.2±3.6 months. While 30 eyes (53.6%) underwent primary IOL implantation, 26 eyes (46.4%) remained aphakic and were subsequently corrected with spectacles or contact lenses. At the last follow-up appointment, which lasted an average of 36.7±5.2 months, 38% of the eyes had a best corrected visual acuity (BCVA) of 6/18 or higher. In aphakic eyes, the average refractive error at the last follow-up was +4.3±2.1 D, while in pseudophakic eyes, it was +1.7±1.3 D. In 25% of instances, YAG capsulotomy or surgical membranectomy was used to address posterior capsular opacification. The visual outcomes were significantly affected by compliance with amblyopia therapy (p < 0.05).
Conclusion: Patients with congenital cataracts who undergo surgery before the age of two have a good chance of having good eyesight in the long run if they also get the right glasses and amblyopia treatment. The dynamic changes in this population's refractive errors must be managed with tailored refractive correction and regular monitoring. Although sustained refractive outcomes seem to be possible with primary IOL implantation, it is crucial to carefully choose patients for this procedure.
