Long-term outcome of primary versus secondary intraocular lens implantation after simultaneous removal of bilateral congenital cataract

Long-term outcomes of intraocular lens (IOL) implantation for congenital cataract in children under 2 years old are still undetermined. We retrospectively reviewed all cases of bilateral congenital cataract who had undergone simultaneous bilateral cataract removal with posterior capsulotomy and central anterior vitrectomy between 1990 and 2010. Patients randomly underwent primary IOL implantation or secondary IOL implantation after a period of contact lens wear. The two groups were compared for visual outcome and complications during follow-up. Cataract removal and primary IOL implantation was performed in 30 eyes (15 patients; nine males, six females) at a mean age of 6.8 +/- 4.2 months. After 79.31 +/- 63.4 months, best-corrected visual acuity (BCVA) was 0.53 +/- 0.36 EDTRS LogMAR. In 36 eyes (18 patients, 11 males, seven females) the lens was removed at a mean age of 5.42 +/- 2.80 months, and after 32.0 +/- 6.1 months of contact lens utilization, secondary IOL implantation was performed. After 109.0 +/- 33.8 months, BCVA was 0.54 +/- 0.4 ETDRS LogMAR. The association between age at surgery and final visual acuity and the difference between the two groups concerning type of cataract at baseline, BCVA and refractive error at last visit, incidence of posterior capsular opacification, glaucoma, strabismus, and nystagmus during follow-up were not significant (p > 0.05). Myopic shift was more frequent in eyes undergone primary IOL implantation (p < 0.001). Similar visual outcome and complications were observed during long-term follow-up after both primary and secondary IOL implantation following simultaneous bilateral congenital cataract removal with posterior capsulotomy and central anterior vitrectomy.