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Unilateral pediatric cataract surgery associated with lower visual acuity, greater myopic shift
Eur J Ophthalmol. 2009;19:754-761.
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Bilateral IOL implantation resulted in better visual outcomes than unilateral implantation in children with congenital cataract, according to a study.
"Reasonably good postoperative visual acuity was achieved in the bilateral cataracts group, but relatively poor acuity in the unilateral cataract group," the study authors said. "Poor stereopsis was recorded in both groups."
The study included 40 children age 5 years or younger who underwent surgery with IOL implantation for congenital cataract and had at least 5 years of follow-up.
The bilateral cataract group comprised 18 patients and the unilateral group comprised 22 patients. Investigators examined visual acuity, refraction, stereopsis and IOP. They gathered data on preoperative, intraoperative and postoperative details from patient records.
The bilateral cataract group had a mean final best corrected logMAR visual acuity of 0.57. The unilateral cataract group had a mean final best corrected logMAR visual acuity of 0.91.
Nystagmus was identified in 10 children (56%) in the bilateral cataract group and five children (23%) in the unilateral group. Strabismus was identified in 14 children (78%) in the bilateral cataract group and 19 children (86%) in the unilateral group.
No cases of retinal detachment were reported, and one child developed glaucoma. A significant myopic shift was found in the unilateral cataract group.
"Effective primary capsulotomy and elective anterior vitrectomy are mandatory to keep a clear visual axis," the authors said.
As expected, visual acuity in the pseudophakic eye was worse for children who underwent surgery for unilateral congenital cataract when compared with children who underwent surgery for bilateral congenital cataracts. Amblyopia may certainly account for some of this vision loss and always needs to be considered and treated aggressively.
– Jean E. Ramsey, MD, MPH
Director,
Pediatric Ophthalmology Service, Boston Medical Center, Associate Professor of
Ophthalmology and Pediatrics, Boston University School of Medicine