Long-Term Outcomes Of Unilateral Vs Bilateral Pediatric Cataract Surgery

Congenital cataracts require early diagnosis and surgery to prevent severe visual impairment. The Infant Aphakia Treatment Study (IATS) suggests that primary IOL implantation is not routinely performed in infants under 6 months in unilateral cases, as long-term outcomes are similar between aphakic infants using optical correction and those receiving primary IOL implantation. However, data comparing unilateral and bilateral cataract cases with long-term follow-up are limited.

Schneider Medical Center

This retrospective study reviewed pediatric patients who underwent cataract surgery at Schneider Medical Center from 2010 to 2016 by a single surgeon, with at least five years of follow-up. The study analyzed demographic data, best corrected visual acuity (BCVA), intraocular pressure (IOP), refractive outcomes, strabismus, glaucoma development, and the need for additional surgeries.

A total of 55 eyes were included: 23 in the unilateral and 32 in the bilateral cataract group. The mean age at surgery was 4.79±4.64 years (range: 1 month–16.92 years), with a mean follow-up of 6.66±2.37 years. BCVA was significantly better in the bilateral group (p=0.002), and more unilateral patients had VA worse than 6/12 (p<0.001). Primary IOL implantation was more common in the bilateral group (p=0.070). Unilateral cases required more post-cataract surgeries, including YAG capsulotomy, strabismus surgery, and anterior vitrectomy (p=0.027). Glaucoma rates did not differ significantly (p=0.392). Multivariable regression identified patient age, laterality, and IOL placement as significant predictors of better VA (p<0.05).

Unilateral cataracts were associated with worse visual outcomes, a higher likelihood of achieving VA worse than 6/12, and a greater need for secondary surgeries compared to bilateral cataracts. These findings highlight the importance of targeted post-surgical management in unilateral cases