Visual and motor outcomes following surgery in children with congenital cataracts: a study of a series of 143 cases

Data on long-term visual and ocular motility outcomes after congenital cataract surgery remain limited. We retrospectively reviewed all surgical cases in our database to evaluate these outcomes and to identify prognostic factors using multivariate analysis. A retrospective analysis of patients who had congenital cataract surgery and secondary intraocular lens (IOL) implantation was conducted. Whenever possible, visual and motor outcomes were collected at each visit. In total, 233 eyes from 143 patients were included, with 90 bilateral and 53 unilateral cases. Statistical analyses included t-tests, Mann–Whitney U-tests, chi-square tests, and multivariate linear regression to evaluate associations and identify independent predictors of postoperative visual outcomes. Patients were followed for a median of 6 years (range 1–15 years). At the final visit, the mean best corrected visual acuity (BCVA) in logarithm of the minimum angle of resolution (logMAR) units was 0.22 logMAR (≈ 20/32; range 20/20–20/66) in bilateral cases and 1.0 logMAR (≈ 20/200; range 20/50 − 20/400) in unilateral cases. Strabismus was present before surgery in 21.3% of bilateral and 30% of unilateral patients, rising postoperatively to 45.3% and 62%. Nystagmus was initially seen in 14.6% of patients and remained postoperatively in 20% of bilateral and 5.7% of unilateral cases. Myopic shift (MS) occurred in 37.2% of eyes; 62.8% remained hyperopic. Spectacle/contact lens adherence was 86.9% in bilateral and 72.7% in unilateral cases. Eyes with normal interocular axial length difference (IALD, defined as < 0.5 mm) showed better BCVA than those with similar or different IALD (p = 0.004). Final BCVA was significantly associated with adherence to treatment, cataract laterality, presence of nystagmus, and amblyopia therapy compliance (F = 13.789, p < 0.001). These results show that timely surgery alone is not enough to get good visual and motor outcomes in congenital cataracts. Adherence to visual rehabilitation, cataract laterality, and the presence of nystagmus were the three most critical things that affected the final visual acuity in our sample. It is very crucial to keep up with regular follow-ups and make sure that treatment is followed in unilateral cases because these people are more likely to get amblyopia and interocular imbalance. Early diagnosis, well-planned surgery, and long-term care that is tailored to each person’s needs are all necessary for the best results.