Long-term results of pediatric cataract surgery after delayed diagnosis

PurposeTo report the long-term rates of visual impairment in children who underwent cataract surgery after late diagnosis.MethodsThe records of children who underwent cataract surgery in northern China between January 1994 and December 2009 were retrospectively reviewed. Age at surgery, surgical approach, postoperative best-corrected visual acuity, and compliance with amblyopia treatment were evaluated. Visual impairment was defined as best-corrected visual acuity <20/60.ResultsOf 486 children included in this study, 2 (0.4%) had surgery by age 3 months and 68 (14%) by age 6 months. Of the 536 eyes of 331 patients with visual acuity recorded at final follow-up, 151 eyes (37%) had bilateral cataract and 82 (65%) had unilateral cataract, with a total of 233 (45%) considered visually impaired. In children who had surgery before 36 months of age for bilateral cataracts, there was no significant difference in rates of visual impairment with versus without primary IOL implantation. In patients with unilateral cataract, visual impairment occurred regardless of age at surgery or whether IOL was primarily implanted. Postoperatively, compliance with amblyopia treatment was good in 30% of patients, fair in 45%, and poor in 31%.ConclusionsThe long-term visual acuity was unfavorable in approximately half of children diagnosed and treated for pediatric cataracts after 3 months of age. Contributing factors included age at presentation and absence of effective training for postoperative vision rehabilitation.