5-Year Outcomes Of Pediatric Cataract Surgery: Comparison According To The Timing Of Surgery

To present the 5-year outcomes obtained from the infantile cataract surgery in pediatric population, comparing results according to the time of surgery.

This study took place in the Department of Ophthalmology of Centro Hospitalar e Universitário de São João, a tertiary referral center in Porto, Portugal.  

Medical records of all patients with unilateral or bilateral infantile cataracts who had undergone lensectomy and anterior vitrectomy with or without intraocular lens implantation (IOL) before 10 years of age were evaluated. All the procedures were performed with posterior capsulorrexis, anterior vitrectomy and cornea suturing. The following exclusion criteria were considered: history of ocular trauma, retinal or corneal dystrophy, ocular or orbital surgery, retinopathy of prematurity or raised intraocular pressure at the time of diagnosis.

Results were considered in two groups: surgery before 12 months (group 1) and surgery after 12 months (group 2). 

54 eyes of 41 patients were included in the first group and 20 eyes from 15 patients in the second one. IOL implantation was performed in the time of lensectomy in 17 eyes of the first group, while it was performed in all the patients of the second one. Systemic malformations were present in 6 of the patients in the first group and none of the patients in the second one. 

Best corrected visual acuity was significantly higher in the second group (p<0,05). Amblyopia, strabismus, nystagmus and intra-ocular hypertension were more prevalent in the patients operated in the first year. When surgery was performed before 12 months, lensectomy combined with IOL implantation do not seem to have more complications than aphakic patients (p>0,05). 

Lower visual acuity outcomes and higher complications rates are more common in cataract surgeries performed before 12 months of age. Since newborn screening programs in developed countries allow a prompt diagnosis of congenital cataracts, the poorer outcomes in the first group reflect the higher severity of the disease in these patients. These results show that it is not possible to compare results without considering time of diagnosis and severity of the cataract in the pediatric population. Furthermore, the higher rate of amblyopia, strabismus and glaucoma in the younger group should prompt a more scrupulous follow-up in these patients.