ESCRS - FP20.05 - Should We Consider Surgery In Unilateral Congenital Cataract Before 6 Weeks Of Age For Better Visual Acuity Results And Take Chamber Angle Glaucoma Surgery As A Necessary Secondary Procedure? – Long-Time Results Will Tell.

Should We Consider Surgery In Unilateral Congenital Cataract Before 6 Weeks Of Age For Better Visual Acuity Results And Take Chamber Angle Glaucoma Surgery As A Necessary Secondary Procedure? – Long-Time Results Will Tell.

Published 2025 - 43rd Congress of the ESCRS

Reference: FP20.05 | Type: Free paper | DOI: 10.82333/ek43-e457

Authors: Shawn Sapir* 1 , Michael Mimouni 2 , Tzahi Sela 3 , Gur Manzur 3 , Igor Kaiserman 4

1Barzilai University Medical Center,Ashkelon,Israel, 2Rambam Medical Center,Haifa,Israel, 3Care Laser vision center ,Tel-Aviv,Israel, 4Barzilai University Medical Center,Tel-Aviv,Israel

Purpose

To evaluate glaucoma rate, treatment and visual acuity prognosis at different times of surgery in a group of unilateral dense congenital cataracts, scheduled for surgery before 3 months of age. Eyes that without early intervention will have a very poor visual outcome.  

Setting

Since 2007 the paediatric cataract register (PECARE) prospectively collects data on all paediatric cataract surgeries in Sweden. The register is national and after 2012 only two sites in Sweden perform all cataract surgeries in children below the age of three. The 2 centre are Sahlgrenska University hospital in Gothenburg (SUHG) and St Eriks Hospital, Stockholm (SEHS). This is a register study from PECARE.

Methods

Between 2007 and 2023, PECARE had 1345 eyes, 625 in girls, registered. 511 were unilateral cataracts and 834 bilateral. Out of 655 eyes with surgery under the age of 2 years 347 were over 6 weeks. The glaucoma frequency was 14.5% in unilateral and 17.1% in bilateral. However, children over the age of 3 months may have developmental cataract and different comorbidity, and only surgery before 3 months of age was included. 134 unilateral (54% girls). Only 80 eyes with at least the 5 years follow up were finally included. 31 eyes were aphakic, 29 had one piece and 20 Bag-in-the-lens IOL. The secondary glaucoma treatment differed, SUHS had a protocol with trabeculotomy primary and shunt secondary, SEHS differed between individuals.

Results

Of the 80 unilateral cases included 44 (55 %) were in girls. The glaucoma rate, in an at least 5 years follow-up of eyes with surgery after 6 weeks but before 3 months of age was 3/16 (18,8%). Unilateral cataracts operated before 6 weeks had a 29/64 (45,3%) rate. In the glaucoma group 13 had surgery with the trabeculotomy first protocol. 10 eyes had their glaucoma during their first year of life, 1 eye before 2 one before 5 and one before 10 years of age.  1 patient had a shunt as secondary procedure, performed during the first year. The visual acuity VA was 0.64 (surgery<6weeks) to 1.17 (surgery>6weeks) logMAR p=0.003. In the <6w group 7 eyes had 0.30-0.15 logMar and 7 had 0.40-0.52 logMAR. In the >6 w group no eye had <0.6 logMAR.

Conclusions

Surgery in unilateral congenital cataracts before 6 weeks of age increases the possibilities of good visual outcome dramatically but at the price of higher rates of early secondary glaucoma. In the time studied chamber angle surgery however seemed to have had a good result with only 1 eye that needed further surgery. Glaucoma frequencies are known to increase by the number of years followed up. Only long-term follow up will reveal whether these eyes will benefit from early intervention and having the glaucoma surgery in early compared to adult age.