Effects of Age at Surgery and Laterality of Cataract on Visual Acuity 5 Years after Surgery in Infants Left Aphakic

Purpose To evaluate 5-year visual acuity (VA) outcomes by age at surgery and laterality among infants left aphakic at initial lensectomy. Design Prospective Pediatric Eye Disease Investigator Group cataract registry. Participants A total of 149 infants (203 eyes; 123 with bilateral surgery) underwent surgery before 12 months of age (median, 1.8; range, 0.6–11.6 months) for nontraumatic cataract without preexisting glaucoma or anterior/posterior segment anomalies who were left aphakic. Methods Records were reviewed annually for 5 years after surgery. Children were grouped by age at first surgery (<2 months, 2 to <6 months, and 6 to <12 months). Analyses accounted for nonindependence of eye pairs. Main Outcome Measures Mean VA and proportion of eyes with VA better than 20/200. Results Eighty-nine (60%) infants were female, 114 infants (77%) were White, 17 infants (11%) were Black, and 21 infants (14%) were Hispanic or Latino. In unilateral cases (N = 80), surgery before 2 months of age was associated with better mean VA at 5 years than with surgery between 2 and <6 months of age (0.79 vs 1.13 logarithm of the minimum angle of resolution [logMAR], difference = 0.34 [95% CI, 0.08–0.59], P = 0.01). In bilateral cases (N = 123), age at surgery was not associated with 5-year VA outcomes ( P = 0.18). A larger proportion of bilaterally operated eyes had VA better than 20/200 compared with undergoing unilateral surgery before 2 months (87% vs 61%; difference = 26% [95% CI, 8%–43%]; P = 0.004) and 2 to <6 months of age (95% vs 23%; difference = 72% [95% CI, 55%–90%]; P < 0.001). Conclusions For bilateral surgery in the first year of life, 5-year VA did not differ by age at surgery. However, for unilateral cataract, 5-year VA was better with surgery before 2 months of age compared with 2 to <6 months. These observations may inform surgical decision-making when treating a cataract in the first 2 months of life. Given the increased risk for glaucoma with early cataract surgery, the surgeon may choose a modest delay in the timing of surgery, accepting a decrease in the VA outcome for unilateral cases. Financial Disclosure(s) Proprietary or commercial disclosure may be found after the references.