Approach to congenital cataract: case series analysis

Introduction: Congenital cataract is an important cause of poor visual acuity and amblyopia, with an incidence of 0,4%. Surgical approaches in children present many advances through the years, such as intraocular lenses implantation and others thechniques, wich results in better visual outcomes and prevention of amblyopia. Purpose: To report the early outcomes of a series of cases submited to different surgical techiniques for pediatric cataract, in the Tadeu Cvintal Ophthalmology Institute, from January 2004 to January 2005. Methods: Retrospective study in 19 children (32 eyes) with congenital cataract. The surgical management was separated in three series: pars plana lensectomy, phacoaspiration with or without intraocular lenses; and also separated in patients who had been submitted to posterior capsulotomy. Visual acuity has been tested with four months of follow up. Results: Lensectomy was performed on eight cases, phacoaspiration with intraocular lenses implantation on 13, phacoaspiration without intraocular lenses on 11. Ten eyes had primary posterior capsulotomy, 13 had secondary posteior capsulotomy one month after initial surgery, nine did not need secondary surgery for capsular opacification. The only observed complication was capsule opacification in 60% of the cases. Fourteen (14) eyes (43%) had visual acuity between 20/20 and 20/40 (LoGMAR_+ 0.0 to + 0.3), from which eight were operated on bilateral cataract. The mean age in the group with best visual acuity was 7 yrs old. Seven eyes from this group (50%) had phacoaspiration with intraocular lenses implantation, and five (35%) with secondary capsulotomy. Conclusions: This series showed good visual and functional early outcomes, even with a small and heterogeneous sample. A longer follow-up is needed to evaluate the different prognosis for each surgical technique.