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J AAPOS. 2009 Feb;13(1):67-71. doi: 10.1016/j.jaapos.2008.07.010. Epub 2008 Dec 12.

The critical period for surgical treatment of dense congenital bilateral cataracts.

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  • 1Retina Foundation of the Southwest, Dallas, Texas; Department of Ophthalmology, University of Texas Southwestern Medical School, Dallas, Texas.

Abstract

INTRODUCTION:

We examined the critical period for deprivation amblyopia in a cohort of patients with dense bilateral congenital cataracts to investigate the optimum timing for surgical treatment.

METHODS:

Thirty-seven infants with dense bilateral congenital cataracts that were extracted by 31 weeks of age were enrolled prospectively. Visual acuity outcome was assessed at >/=5 years of age. We statistically evaluated which of 4 models provided the best fit to the data: (1) no change in visual acuity outcome with delay in surgery, (2) linear decline of outcome with delay, (3) a bilinear model in which a critical age exists after which outcome depends on delay, and (4) a bilinear model in which a critical age exists before which outcome depends on delay. In addition, we reviewed medical records for associated adverse outcomes, including strabismus, nystagmus, secondary membrane formation, and glaucoma.

RESULTS:

A bilinear model with a critical age of 14 weeks fit the data better than a linear model (chi(2) = 14.7; p < 0.0006). During weeks 0-14, mean visual acuity decreased by 1 line with each 3 weeks' delay in surgery. From 14 to 31 weeks, visual acuity was independent the subject's age at surgery, averaging 20/80. Surgery after 4 weeks was associated with a greater prevalence of strabismus and nystagmus than surgery before 4 weeks, whereas surgery during the first 4 weeks was associated with a greater prevalence of secondary membrane formation and glaucoma.

CONCLUSIONS:

We did not find a latent period for the treatment of children with dense bilateral congenital cataracts. Deprivation amblyopia may be minimized with early surgery for bilateral cataracts.

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