Stability of visual outcome from 7years in children treated surgically for bilateral dense congenital cataracts before 37weeks of age

Acta Ophthalmol. 2011: 89: 30-36 Purpose: To study the long-term visual outcome and the age at which final visual acuity can be predicted in a population sample of children treated surgically for bilateral dense congenital cataract before 37weeks of age. In addition, we assessed the influence of associated risk factors and compared the visual development of these aphakic children with presumably blocked visual input before early surgery to that of normal children in Sweden. Methods: The 18 patients included were followed for at least 10years postoperatively. The median age at last visit was 15.5years (range 10-18). The best-corrected visual acuity (BCVA) was tested monocularly with a logarithmically scaled letter acuity test from 4years of age to late teens. Other registered postoperative data were presence of manifest nystagmus, strabismus and complications. Results: The BCVA of the better-seeing eye reached a plateau at 7years of age. Age at surgery of 80days or less characterized the majority of cases with a logMAR less than or equal to 0.3 with a threshold effect between 80 and 130days of age. Compared to normal children in Sweden, the long-term visual outcome showed a deficit of 0.5-0.6 logMAR. Conclusion: In spite of optimized care and surgery before 9months, the BCVA was subnormal in our population compared to healthy children. The long-term visual outcome can be predicted at 7years of age. Screening with early detection followed by surgery before the end of the third month is important to decrease the risk of marked acuity loss.