Intraocular lens implantation in children with unilateral congenital cataract in the first 4 years of life

Purpose: To describe the outcome of phacoaspiration with intraocular lens implantation in children with unilateral congenital cataract in the first 4 years of life. Methods: A retrospective chart review of children with visually significant unilateral congenital cataract presenting in the first 4 years of life was done. Children with a minimum postsurgical follow-up of 1 year were included. Outcome measures were mean spherical equivalent, visual axis clarity, visual acuity and complications till the last follow-up. Results: Ninety-three children met the inclusion criteria. The mean age of surgery was 13.23 +/- 11.89 months and the mean follow-up period was 24.37 +/- 17.35 months. Nearly 40% of children presented during their first year of life. No difference was noted between the subgroups in terms of age (p = 0.310), sex (p = 0.475) or laterality (p = 0.349). Surgical membranectomy was performed in 22 eyes (23.6%) after an average period of 4.85 +/- 2.58 months after surgery. One eye underwent piggy back intraocular lens and four eyes underwent intraocular lens exchange after a mean duration of 50 months (range 40-60 months). The mean visual acuity was 0.79 +/- 0.11 (log MAR chart). A total of 60.7% of these children (n = 31) achieved best corrected visual acuity or 20/80 or better. Conclusion: The results of our study suggest that primary intraocular lens implantation in children with unilateral congenital cataract gives good structural and functional results. Besides a meticulous surgery, visual outcome is affected by the time of presentation and postoperative compliance to amblyopia therapy.