When should the surgery be performed?
Bilateral cataracts
Jain et al . (JAAPOS 2010;14(1):31-34), in a retrospective review of dense bilateral congenital cataracts, found that visual acuity after surgery for bilateral congenital cataracts appears to decline exponentially with duration of visual deprivation.
Birch et al . (JAAPOS 2009;13(1):67-71) assessed the 5-year visual outcome in infants operated for dense bilateral congenital cataracts. They noted that during weeks 0-14, mean visual acuity decreased by 1 line with each 3 weeks’ delay in surgery. From 14 to 31 weeks, visual acuity was independent of the subject’s age at surgery, averaging 20/80. It was also noted that surgery after 4 weeks was associated with a greater prevalence of strabismus and nystagmus than surgery before 4 weeks, whereas surgery during the first 4 weeks was associated with a greater prevalence of secondary membrane formation and glaucoma.
Lambert et al . (JAAPOS 2006;10(1):30-6) performed a retrospective analysis of children with dense bilateral congenital cataract and noted that a best-corrected visual acuity (BCVA) of 20/100 or worse occurred only among eyes undergoing surgery when infants were older than 10 weeks. They also reported that absence of preoperative nystagmus was a better predictor of a good visual outcome than the age at surgery.
Watts et al . (JAAPOS 2003;7(2):81-5) suggested that the first 2 weeks of life comprise the most favorable time for decreasing postoperative complications resulting from surgical intervention for infants presenting with cataracts within the first 12 weeks of life.
Unilateral cataracts
Birch et al . (Invest Ophthalmol Vis Sci. 1993;34(13):3687-99) found that treatment initiated at 1-6 weeks of age in congenital unilateral cataract maximizes the opportunity for normal or near-normal visual development with little or no risk to the phakic fellow eye.
Birch et al . (Invest Ophthalmol Vis Sci. 1996;37(8):1532-8), in another study of dense congenital unilateral cataracts, reported that intervention before 6 weeks of age may minimize the effects of congenital unilateral deprivation on the developing visual system and visual rehabilitation.
Birch et al . (Invest Ophthalmol Vis Sci. 1998;39(9):1560-6), in a comparative study between unilateral and bilateral cataracts, observed that patients with a history of unilateral cataract showed greater deficits in contrast sensitivity when treatment was initiated later (i.e., at 12-30 weeks). It was hypothesized that only visual deprivation is active as an amblyogenic factor during the first weeks of life, but when unilateral deprivation is prolonged to 12-30 weeks, unequal competition also plays a role in amblyogenesis.
Sinha, Rajesh, et al. “Management of congenital cataract: A review.” Indian Journal of Ophthalmology, vol. 58, no. 6, Nov.-Dec. 2010, p. 563. Gale Academic OneFile, https://link-gale-com.i.ezproxy.nypl.org/apps/doc/A241320149/AONE?u=nypl&sid=AONE&xid=80b30689. Accessed 22 Mar. 2020.
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