Ten-year outcomes of congenital cataract surgery performed within the first 6 months of life

Tetsuro Oshika; Sachiko Nishina; Noriyuki Unoki; Mai Miyagi; Koji Nomura; Takafumi Mori; Naoko Matsuki; Takao Endo; Daijiro Kurosaka; Kazuno Negishi; Shigeo Yoshida; Toshiyuki Nagamoto

doi:10.1097/j.jcrs.0000000000001449

Ten-year outcomes of congenital cataract surgery performed within the first 6 months of life

J Cataract Refract Surg. 2024 Mar 22. doi: 10.1097/j.jcrs.0000000000001449. Online ahead of print.

Authors

Affiliations

¹ Department of Ophthalmology, Faculty of Medicine, University of Tsukuba, Ibaraki, Japan.
² Division of Ophthalmology, National Center for Child Health and Development, Tokyo, Japan.
³ Osaka City General Hospital, Osaka, Japan.
⁴ Aichi Children's Health and Medical Center, Aichi, Japan.
⁵ Hyogo Prefectural Kobe Children's Hospital, Hyogo, Japan.
⁶ Department of Ophthalmology, Fukushima Medical University, Fukushima, Japan.
⁷ Department of Ophthalmology, Kyorin University School of Medicine, Tokyo, Japan.
⁸ Osaka Women's and Children's Hospital, Osaka, Japan.
⁹ Department of Ophthalmology, Iwate Medical University School of Medicine, Iwate, Japan.
¹⁰ Department of Ophthalmology, Keio University School of Medicine, Tokyo, Japan.
¹¹ Department of Ophthalmology, Kurume University School of Medicine, Fukuoka, Japan.
¹² Nagamoto Eye Clinic, Tokyo, Japan.

PMID: 38517986
DOI: 10.1097/j.jcrs.0000000000001449

Abstract

Purpose: In the spectrum of pediatric cataract, genuine congenital cataract poses challenges and has a poorer prognosis than developmental cataract. We investigated the long-term outcomes of congenital cataract surgery performed within the first 6 months of life.

Setting: Eleven ophthalmic surgical sites in Japan.

Methods: Medical charts were retrospectively reviewed for 216 eyes of 121 patients. The age at surgery was 2.9 ± 1.7 months, with follow-up duration 13.0 ± 2.3 years. The cohort consisted of 83 cases with bilateral aphakia, 12 with bilateral pseudophakia, 20 with unilateral aphakia, and 6 with unilateral pseudophakia.

Results: Surgical intervention within the critical period of visual system development (10 weeks for bilateral and 6 weeks for unilateral cases) led to significantly better final visual acuity than surgery conducted after this timeframe. The incidence of secondary glaucoma was similar between groups, while the occurrence of visual axis opacification was more frequent with earlier surgery. A forward stepwise multiple regression analysis revealed that the final visual acuity was significantly associated with laterality of cataract (better outcomes in bilateral cases), phakic status (with pseudophakia outperforming aphakia), presence of systemic and ocular comorbidities, and development of secondary glaucoma. Secondary glaucoma was significantly more prevalent in aphakic eyes than pseudophakic eyes.

Conclusions: In patients with genuine congenital cataract, surgery within the critical period of visual development results in better final visual acuity, albeit with an increased risk of visual axis opacification. The use of intraocular lens with sophisticated surgical techniques shows promise even in congenital cataract surgery.