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

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 37 weeks 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 10 years postoperatively. The median age at last visit was 15.5 years (range 10-18). The best-corrected visual acuity (BCVA) was tested monocularly with a logarithmically scaled letter acuity test from 4 years 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 7 years of age. Age at surgery of 80 days or less characterized the majority of cases with a logMAR ≤ 0.3 with a threshold effect between 80 and 130 days 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 9 months, the BCVA was subnormal in our population compared to healthy children. The long-term visual outcome can be predicted at 7 years 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.