A recent study in London assessed the surgical outcomes of infants and children with cataract associated with microphthalmia, microcornea or persistent fetal vasculature, and compared them with those of children with isolated cataract. Researchers found that, when comparing early (infants 48 days or younger) and later intervention for infants with the conditions, the proportion of eyes with poor visual acuity was still the same. In the isolated cataract group, the proportions of eyes with better visual outcomes favored later intervention.

Researchers reviewed 111 children (25 of whom had cataract associated with the three congenital anomalies) who underwent cataract surgery before the age of 16. Median age at surgery was 3.9 months for cataract associated with the conditions and 23.3 months for isolated cataract. The median duration of follow-up was 95.9 months. Of the children with one of the congenital disorders, 28% also had a high prevalence of glaucoma, which was more significant after early intervention (75%) than after late (6%). Of the children with isolated cataract, 15% developed glaucoma, with a higher prevalence after early intervention (42%) rather than late (11%).

The authors believe that the high risk of glaucoma infants, especially those with the concomitant disorders, should discourage early surgical intervention in these children.

Daniel MC, Adams GGW, Dahlmann-Noor A. Medical management of children with congenital/infantile cataract associated with microphthalmia, microcornea or persistent fetal vasculature. J Pediatr Ophthalmol Strabismus. 2019;56(1):43-49.