Early surgery for dense congenital bilateral cataracts may minimize deprivation amblyopia

Researchers prospectively studied the outcomes of children with dense bilateral congenital cataracts that were extracted by 31 weeks of age. They found that the best fit for the results was a bilinear model of the critical period for surgery, with long-term visual acuity outcomes declining linearly during the first 14 weeks of life and remaining unchanged with further delays. Patients who underwent surgery by four weeks had long-term visual acuity outcomes of at least 20/60 and a lower prevalence of strabismus and nystagmus but also a greater prevalence of secondary membrane formation and glaucoma.

Data were drawn from the long-term follow-up results of a large ongoing prospective cohort of infants with dense bilateral congenital cataracts diagnosed during the first week of life. Included in this study were 37 cohort members age five and older with good contact lens or spectacle compliance who had not undergone secondary IOL implantation and did not have associated retinal anomalies, systemic disease or neurological disorders. Mean visual acuity decreased by one line with each three weeks' delay in surgery up to 14 weeks of age.