Visual and sensory results of surgical treatment of cataract in children. Apropos of 135 cases

Objective: Visual outcome after cataract surgery in children.

Methods: The authors studied the functional results (visual acuity and binocular vision) of 135 children operated for unilateral or bilateral cataracts during the 9-year period 1985-1994. Aphakia was corrected by an implant within the capsular bag, spectacles or contact lenses.

Results: For bilateral cataracts, (68 patients), mean visual acuity > 20/40 and normal binocular vision are found together in cases of late appearance operated after 7 months of age. Pseudophakic eyes regained visual acuity greater than 20/40 more often than non-implanted eye, with a statistically significant difference (P < 0.001). Binocular vision was also obtained more often in children after implantation (P < 0.05). The functional results of operations on early cataracts treated before the age of 8 months were not as good because of abnormal development of the foveolar function. For unilateral cataracts (67 patients), the prognosis was poor when operated before the age of 8 months. Visual acuity rarely exceeded 20/200 however the aphakia was corrected. Prognosis was better for partial cataracts and late-appearing cataracts. Implantation appeared to be of more benefit, with a statistically significant difference (P < 0.05) for visual acuity greater than 20/40 in children receiving an implant.

Conclusions: Regained binocular vision and absence of amblyopia depend on the quality of previous visual experience and absence of post-operative strabismus. Implantation appears beneficial for final visual results.