Objective: The aim of this study was to determine the surgical outcome of childhood cataracts.
Method: Between 1990 and 1997, 137 patients less than 10 years of age (181 eyes) underwent cataract surgery at the Royal Alexandra Hospital for Children/New Children's Hospital. Data were collected retrospectively from medical records and supplemented with data from referrng ophthalmologists.
Results: In the majority of patients (53.0%), the cause of cataract was unknown. Sixty-two patients (45.3%) had bilateral and 75 patents (54.7%) had unilateral cataracts. In 84 patients (107 eyes: 59.1%), the onset of visually significant cataract was estimated to be before the age of 2 years. Reliable postoperatve visual acuity (VA) was obtained in 150 eyes from 116 patients. The mean LogMAR VA was 0.71 +/- 0.55 in bilateral cataracts and 1.17 +/- 0.68 in unilateral cataracts. Visual acuity was poor (LogMARVA > 1.0) in 71.8% of unilateral cataracts (compared to 27.9% in bilateral cataracts, P < 0.0001), and in 64.9% when onset was ess than 2 years (compared to 22.4% in later onset cataract, P < 0.0001). Posterior capsular opacity requiring laser or surgical removal was noted in 40 patients (44 eyes; 24.4%). Other complications included raised intraocular pressure in six patients (seven eyes: 3.7%), displaced intraocular lens or iris capture in 11 patients (12 eyes; 6.6%), ectopic pupil in five patients (five eyes; 2.7%), and severe inflammation in eight patients (12 eyes; 6.6%). There was cosmetically significant esotropia or exotropia in 24 patients (23 eyes; 12.7%).
Conclusion: The prognosis for vision was significantly poorer in unilateral and earlier onset cataract. The importance of early diagnosis, prompt treatment and vigilant postoperative follow up in this subgroup cannot be overemphasized.