Visual outcomes following congeni-

tal cataract surgery have improved

because of the better understanding of
the sensitive periods for the devel-
opment and reversal of amblyopia, the
timing of cataract removal, and
improved surgical techniques (Ledoux
et al. 2007). Most paediatric ophthal-
mologists agree that intraocular lens
(IOL) implantation is the appropriate
treatment of aphakic rehabilitation in
paediatric cataract surgery (Bartholo-
mew et al. 2003). Primary IOL implan-
tation has become the preferred
approach in children above 2 years, but
IOL implantation in children under
2 years remains controversial as these
eyes are more susceptible to intense
posterior capsular opacication (PCO)
and excessive uveal inammations
(Basti et al. 1996; Wilson 1996). Pri-
mary IOL implantation for the treat-
ment of congenital cataracts in patients
younger than 1 year of age has been
carried out in some cases. Although
there is huge debate about the timing of
IOL implantation, primary aphakia,
aphakic correction with glasses, and
secondary IOL implantation around
2 years of age can be the better method
to prevent the complications which
are mentioned earlier (Ahmadieh &
Javadi 2001; Bartholomew et al. 2003).
Long-term results of bilateral
congenital cataract treated with
early cataract surgery, aphakic
glasses and secondary IOL
implantation
Dong-Hyun Kim,
1
Jeong Hun Kim,
1,2
Seong-Joon Kim
1,2
and Young Suk Yu
1,2
1
Department of Ophthalmology, Seoul National University College of Medicine,
Seoul, Korea
2
Seoul Articial Eye Center, Seoul National University Hospital Clinical Research
Institute, Seoul, Korea
ABSTRACT.
Purpose: To evaluate the long-term visual outcome after early surgery of bilat-
eral dense congenital cataracts, aphakic correction with glasses and secondary
intraocular lens (IOL) implantation around 2 years of age.
Methods: The medical records of paediatric patients who underwent cataract
extraction, aphakic correction and secondary IOL implantation from 1993 to
2004 at Seoul National University Childrens Hospital were reviewed retro-
spectively. Age at secondary IOL implantation, axial length (AL), best cor-
rected visual acuity (BCVA), refractive error, ocular alignment, stereopsis,
and postoperative ocular complications were recorded.
Results: Thirty-seven paediatric bilateral pseudophakic patients were identied
with a mean follow-up period of 81.4 months. Best corrected visual acuity of
20 40 or better were attained in 44.0% of eyes, and the median BCVA was
20 50. Preoperative factors associated with poor visual prognosis included cat-
aract surgery after 8 weeks of age, interocular AL difference of 0.5 mm or
more, and glaucoma. Amblyopic eyes showed more myopic change compared
to fellow eyes. Good or moderate binocular function was achieved in 18.9% of
all patients. Incidences of strabismus, glaucoma, posterior capsular opacity
formation were 46.0%, 32.4% and 4.0%, respectively.
Conclusion: Good postoperative BCVA and binocular function were achieved
in most healthy children with bilateral dense congenital cataract and no poster-
ior segment pathology. Early cataract surgery, aphakic correction with glasses
and secondary IOL implantation around 2 years of age appears to be appro-
priate methods.
Key words: bilateral congenital cataract postoperative complication secondary intraocular
lens implantation visual acuity
Acta Ophthalmol. 2012: 90: 231236
2010 The Authors
Journal compilation 2010 Acta Ophthalmol
doi: 10.1111/j.1755-3768.2010.01872.x
Acta Ophthalmologica 2012
231
Intraocular lens implantation after 34-
year-old can decrease the efciency of
aphakic rehabilitation. In previous
studies, there have been few reports
regarding children who have undergone
secondary IOL implantation around
2 years of age for the management of
bilateral congenital cataract. Previous
articles have reported the surgical
results of bilateral congenital cataract
in small sample sizes with short lengths
of follow-up. The aim of this study was
to investigate the long-term clinical
results of early cataract surgery, apha-
kic correction with glasses, and second-
ary IOL implantation around 2-year-
old for the management of bilateral
dense congenital cataract.
Patients and Methods
This was a retrospective study of
children who were diagnosed as bilat-
eral congenital cataract at our depart-
ment between 1993 and 2004. After
obtaining institutional review board
approval, a medical record review was
undertaken. Congenital cataract was
dened when the patients younger
than 6 months had cataract. Patients
who had a co-existing organic ocular
defects, retinopathy of prematurity,
posterior-type persistent hyperplastic
primary vitreous were excluded.
Patients with Down syndrome or sys-
temic diseases able to inuence learn-
ing ability were also excluded. The red
reex was poor in both eyes of all
patients because the cataracts were
dense. All children had previously
undergone simultaneous irrigation and
aspiration (I&A) of the lens, posterior
capsulectomy and anterior vitrectomy
in both eyes within 2 weeks after the
diagnosis of congenital cataract.
Around 2 years of age, these patients
were operated for secondary IOL
implantations of both eyes in separate
surgeries. Preoperative slit lamp
biomicroscopy, fundus examination
and B-scan ultrasonography were per-
formed in all children under sedation
with oral chloral hydrate. Follow-up
examinations in uncooperative chil-
dren were also performed under seda-
tion. Cooperative children were
examined without sedation in follow-
up. Cataracts were categorized to the
type of opacity; total, nuclear and
posterior polar. Intraocular lens
power was calculated with the SRK-II
formula based on axial length (AL)
and keratometry readings. The target
IOL power was selected after taking
into consideration the predicted future
growth of the eye and the consequent
myopic shift. Target IOL power in
children around 2 years of age was
+1.00+4.00 diopters (D). Patients
who showed an interocular AL differ-
ence of 0.5 mm or more were classi-
ed into the different AL group and
those showing <0.5 mm difference
into similar AL group, respectively.
All surgeries were performed by one
experienced surgeon (Y.S. Yu). Under
general anaesthesia, mechanical ante-
rior capsulorhexis, I&A of lens, pos-
terior capsulectomy, and anterior
vitrectomy were performed using vit-
rector. Aphakic correction with
glasses were started 1 week after sur-
gery. During follow-up, the patients
who showed amblyopia received
occlusion therapy. Secondary IOL
implantations were performed through
a 6 -mm sized scleral tunnel incision
2 mm from the superior limbus. One
piece polymethylmethacrylate IOL
were used in all surgeries. The IOL
was inserted in the capsular bag or
xated in the ciliary sulcus. When
inserting in the capsular bag, adhesion
between the anterior and posterior
capsule was dissected with micro-
vitreoretinal blade before IOL implan-
tation. If posterior synechiae or
reproliferated lens material were
found, all were removed before IOL
implantation. In all cases, sodium
hyaluronate 1.4% (Healon GV; AMO
Inc., Santa Anc, CA, USA) was used
and sclerotomy sites or scleral tunnel
incisions were closed with interrupted
8-0 polyglactin sutures.
During regular follow-up after sec-
ondary IOL implantation, manifest or
cycloplegic refraction, measurement of
intraocular pressure (IOP) with pneu-
matic tonometer, strabismus examina-
tion with Krimsky test or alternative
cover test were performed. Visual acu-
ities were measured after 4 years of
age using the Snellen chart. Until 34-
year-old, the patients were examined
every 4 months, Until 78-year-old,
the patients were examined every
6 months. After 9-year-old, yearly
check-up was carried out. Patients
who showed a visual acuity (VA) dif-
ference of two or more Snellen lines
between the two eyes were grouped as
amblyopic patients. Ocular deviations
were measured in prism diopters
(PD). Children with a deviation equal
to or larger than 10 PD were consid-
ered to have strabismus and some
underwent corrective surgery. Sensory
fusion was assessed using the Worth
4-dot test. Fusion was measured at
both near (1 3 m) and at distance
(6 m). Stereoacuity was assessed by
means of the Titmus stereo test. Near
fusion and Titmus stereo test was per-
formed with the children wearing their
near glasses or adding +3.0 D trial
lenses. Binocular function was graded
as good if measured stereo acuity
was 100 seconds of arc or better and
as moderate if measured stereo acu-
ity was between 100 and 200 seconds
and if there was fusion of the Worth
4-dot test at both distance and near.
The eyes in which the IOP was higher
than 25 mmHg were dened as having
glaucoma and were treated either
medically or surgically.
Multivariate analysis was used to
evaluate the factors that inuenced
nal best corrected visual acuity
(BCVA). p-Value of <0.05 was con-
sidered statistically signicant.
Results
From 1993 to 2004, 54 patients were
diagnosed with bilateral congenital
cataract and underwent surgery. Sev-
enty-four eyes of 37 patients were
included in our study. Mean follow-
up period was 81.4 21.3 months
(range 36144 months). The mean age
of all patients at nal follow-up was
7.8 years (range 410 years). Details
of preoperative patient demographics
are listed in Table 1.
Mean age at I&A of lens was
13.6 5.3 weeks (range 426 weeks).
Seven patients underwent cataract sur-
gery before 8 weeks from birth. There
were no children who had strabismus
before cataract surgery. The postoper-
Table 1. Patients demographics.
Number of eyes patients 74 37
Sex
Male 21 (57%)
Female 16 (43%)
Cause
Idiopathic 22 (59%)
Hereditary 15 (41%)
Opacity type
Total 38 (51%)
Nuclear 32 (44%)
Posterior subcapsular 4 (5%)
Acta Ophthalmologica 2012
232
ative refractive error at 3 months after
I&A of lens is shown in Table 2. All
children showed good compliance
with aphakic glasses. Two patients
had visual axis opacication (VAO) at
5 and 20 months after cataract sur-
gery, respectively, and underwent
reoperation. There were no incidences
of glaucoma or strabismus before sec-
ondary IOL implantation.
Mean age at secondary IOL
implantation was 25.9 3.9 months
(range 1730 months). Mean AL at
secondary IOL implantation was
20.88 1.59 mm (range 17.4724.68
mm). The number of patients in the
different AL group was 11. The dif-
ferent AL group showed a longer AL
than the similar AL group, which
was statistically signicant (different
AL: 21.35 1.92 mm, similar AL:
20.70 1.40 mm, p = 0.026, Mann
Whitney test). The numbers of eyes
which were xated to the ciliary sulcus
or implanted in the capsular bag were
62 and 12, respectively. The postoper-
ative refractive error at 3 months after
posterior chamber intraocular lens
(PC-IOL) insertion is shown in
Table 2. Table 3 shows the difference
in target and postoperative refraction
at 3 month after PC-IOL insertion.
The difference between the target and
postoperative refraction was <2 D in
most eyes (52 eyes, 71%). Myopic and
hyperopic shift were present in 54
eyes (73%) and in 20 eyes (27%),
respectively.
Seventeen patients (46%) showed
strabismus at nal follow-up. Exotr-
opia (nine patients, 24%) was more
common than esotropia (seven
patients, 19%). Dissociated vertical
deviation (DVD) was demonstrated in
one patient (3%). The mean prism
deviation was 30 PD in exotropia and
35 PD in esotropia. Five patients
underwent strabismus surgery for ex-
otropia, three for esotropia, and one
for DVD, respectively. Surgical inter-
vention was successful in 80% of stra-
bismus patients, with no evidence of
strabismus recurrence at nal follow-
up. Visual axis opacication devel-
oped in both eyes of one patient at
52 months after secondary IOL
implantation. Glaucoma showed the
highest incidence among the postoper-
ative complications, with 24 eyes
(32%) showing IOP elevation. The
glaucoma rate in the different and
similar AL group was 36% and
31%, respectively. During the period
between I&A of lens and secondary
IOL implantation, there were no inci-
dences of glaucoma.
Glaucoma developed at mean
62 months (range 24102 months)
after I&A of lens, and eight patients
(66%) have glaucoma in 46 years
after I&A. All glaucoma incidences
were in both eyes of a single patient.
Sixteen eyes maintained stable IOP
with the use of a single anti-glaucoma
medication, Cosopt

(MSD, White-
house Station, NJ, USA), and six
eyes, with the use of two or more IOP
lowering agents (Cosopt

, Alphagan

(Allergan, Irvine, USA) and Xalatan

(Pzer, New York, NY, USA)). One

patient received Ahmed operations in
both eyes. Band keratopathy and scle-
romalacia occurred in one eye, respec-
tively.
Final BCVA are summarized in
Table 4. Median BCVA at nal fol-
low-up was 20 50. The mean BCVA
at nal follow-up was better in the
posterior polar type opacity compared
to others, but there were no signicant
differences according to the type
of opacities (p = 0.432, multivariate
analysis). Thirteen patients (35%)
showed a BCVA of 20 40 or better in
both eyes. Twelve patients (32%)
showed a BCVA difference of two or
more Snellen lines between the two
eyes. The mean nal BCVA in
patients who had undergone cataract
surgery before 8 weeks from birth was
0.36 0.23 logMAR (Minimal angle
of resolution) and these patients dem-
onstrated a signicantly better mean
BCVA (0.51 0.41, logMAR) com-
pared to that of patients who received
surgery after 8 weeks (p = 0.046).
The incidence of patients showing a
difference of two or more Snellen line
between both eyes was 20% in the
different AL group and 33.3% in
the similar AL group, respectively.
The mean BCVA in the similar AL
group was better signicantly than
that in the different AL group
(logMAR 0.44 0.35, 0.61 0.47,
p = 0.044). The mean nal BCVA
in strabismus patients was not sta-
Table 2. Postoperative refraction error at postoperative 3 months of irrigation and aspiration
(I&A) of lens, after posterior chamber intraocular lens (PC-IOL) insertion and at nal follow-
up in bilateral congenital cataract patients.
Post I&A (postoperative 3 months) SE: +15.8 D (+11.0+20.5 D)
AST: 0.4 D (02.5 D)
After secondary PC-IOL insertion
(postoperative 3 months)
SE: +1.6 D (+5.8)4.0 D)
AST: 0.7 D (03.0 D)
Final follow-up SE: )1.7 D (+4.5)9.5 D)
AST: 1.1 D (05.0 D)
SE = spherical equivalent; D = diopters; AST = amount of astigmatism.
Table 4. Best corrected visual acuities
(BCVA) at nal follow-up.
BCVA at nal
follow-up Eyes %
20 20 VA 3 3
20 25 VA < 20 20 7 10
20 40 VA < 20 25 23 31
20 100 VA < 20 40 25 34
20 200 VA < 20 100 11 15
VA < 20 200 5 7
Total 74 100
VA = visual acuity.
Table 3. Difference in target refraction and postoperative refraction at postoperative 3 months
of posterior chamber intraocular lens (PC-IOL) insertion in bilateral congenital cataract
patients.
Target refraction post op
3-months refraction (diopters) Number of eyes %
D < )2.0 1 1
)2.0 D < )1.0 5 7
)1.0 D < 1.0 33 45
1.0 D < 2.0 14 19
2.0 D < 3.0 11 15
3.0 D 10 13
Total 74 100
D = diopters.
Acta Ophthalmologica 2012
233
tistically different from that of
orthotropic patients (strabismus
orthotropia: 0.47 0.41 0.42 0.25
(logMAR), p = 0.162). The amblyo-
pia rate in strabismus patients was
higher than that in orthotropic
patients (33% versus 27%). Glaucoma
patients had signicantly worse visual
prognosis than normal IOP patients
[BCVA (logMAR): high IOP 0.59
0.49, normal IOP 0.43 0.32,
p = 0.036]. Overall results are shown
in Table 5.
The refractive error at nal follow-
up is shown in Table 2. The mean
change in myopic regression at nal
follow-up after secondary IOL
implantation in all patients was
)3.3 2.4 D. The mean change in
myopic regression in patients 8 years
or older was )5.5 2.7 D in eyes
whose VA were 20 40 or better and
)5.7 4.3 D in eyes whose VA were
<20 40 (p = 0.064, independent
t-test). The mean change in myopic
regression in amblyopia patients
8 years or older was )5.8 3.1 D in
the fellow eyes and )7.8 3.4 D in
amblyopic eyes (p = 0.001, indepen-
dent t-test). Figure 1 shows the
changes in mean spherical equivalent
(SE) from secondary IOL implanta-
tion to nal follow-up in the groups
of BCVA of 20 40 or better and
<20 40. Figure 2 shows the changes
in SE of the amblyopic and fellow
eyes in patients with amblyopia.
Two patients (5%) showed good
binocular function. Of the patients
whose BCVA of both eyes were 20 40
or better, 15% achieved stereopsis of
100 seconds of arc or less. Seven
patients (19%) showed stereopsis
ranging from 200 seconds of arc to
100 seconds of arc. One patient with
moderate stereopsis at nal follow-up
had undergone strabismus surgery for
exotropia at 24 months after cataract
extraction.
Discussion
The BCVA at nal follow-up in this
study corresponds with the results of
several studies on congenital and
infantile bilateral cataracts performed
during the past 20 years. They report
BCVA of 20 40 or better for over
40% of subjects mostly (Christensen
et al. 1992; Petersen & Robb 1992;
Bradford et al. 1994; Arne et al.
1998). Results from recent studies
regarding primary IOL implantation
in bilateral congenital cataract show
that the median nal BCVA achieved
were 20 63, 20 60, 6 18 (Chak et al.
2006; Gouws et al. 2006; Lundvall &
Zetterstro m 2006). The median BCVA
in this study was 20 50 and 10 eyes
(14%) attained a BCVA of 20 25 or
better. Through these results, we may
assume that primary I&A of lens,
aphakic glasses, and secondary IOL
implantation around 2 years of age
may show better visual prognosis
than early primary IOL implantation.
Our previous study concerning sec-
ondary IOL implantation at various
ages older than 2 years showed a
median BCVA of 20 66 (Kim et al.
2008). It is thought that early visual
rehabilitation using IOL around
2 years will increase visual prognosis.
Because the long-term visual outcome
may be predicted at 7 years of age,
the subjects in our study (mean age:
8-year-old) are proper for evaluation
of long-term visual outcome (Jonsson
et al. 2009).
The critical period for surgical
treatment of congenital cataracts
within the rst 8 weeks of life has
been proposed in several studies (Fel-
lows et al. 1981; Gelbart et al. 1982;
Kugelberg 1992). The superior BCVA
in patients who underwent cataract
surgery before 8 weeks is coincident
with the concept of this critical per-
iod, although there is debate about
Table 5. Multivariate analysis of the best cor-
rected visual acuities (BCVA) according to
clinical features at nal follow-up.
BCVA (logMAR) p-Value
Time of cataract surgery
Before 8 weeks 0.36 0.23 0.046*
After 8 weeks 0.51 0.41
Lens opacity type
Total 0.58 0.49 0.432
Nuclear 0.39 0.22
Posterior polar 0.34 0.12
Axial length (AL)
Similar
AL group
0.44 0.35 0.044*
Different
AL group
0.61 0.47
Strabismus
Orthotropia 0.42 0.25 0.162
Heterotropia 0.47 0.41
Glaucoma
Normal IOP 0.43 0.32 0.036*
High IOP 0.59 0.49
IOP = intraocular pressure.
* Statistically signicant (multivariate analy-
sis).
Fig. 1. Change in mean spherical equivalent from secondary intraocular lens implantation to
nal follow-up according to best corrected visual acuities.
Fig. 2. Change in mean spherical equivalent from secondary intraocular lens implantation to
nal follow-up in amblyopic and fellow eyes.
Acta Ophthalmologica 2012
234
critical period. As lens opacities in all
patients were visually signicant, the
BCVA would be expected to be irre-
spective of the opacity type. The cause
of the difference in BCVA between
the different and similar AL group
will be because of the difference of
stimulus deprivation between both
eyes. Because more deprivation effect
causes longer elongation of the eye
(Wiesel & Raviola 1977; Chalupa
et al. 1982), the longer AL in different
AL group than in similar AL group
will be correlated with worse BCVA.
The higher glaucoma incidence in the
different AL group may be also a fac-
tor for poor visual prognosis.
Mean SE 3 months after IOL
implantation showed myopic change
from the estimated preoperative IOL
power. These changes may be because
of IOL xation in the ciliary sulcus in
most eyes. Given that secondary IOL
implantation into the capsular bag is
a difcult surgical technique, sulcus
xation technique should be used in
most surgeries.
Myopic change in pseudophakic
eyes is larger and more rapid than
phakic eyes and the younger the child
at the time of implantation, greater
the myopic shift (Dahan & Drusedau
1997; Crouch et al. 2002) Children
who underwent IOL implantation at
118 months showed a mean myopic
change of )6.39 3.68 D (Crouch
et al. 2002). Our study showed a myo-
pic change of 3.5 D. Because most eye
growth occurs during the rst 2 years
of life, myopic change in eyes under-
going IOL implantation after 2 years
is less than eyes which receive early
primary IOL implantation. Also the
amblyopic eye showed the more myo-
pic change compared to the fellow
eye. Several previous studies already
showed that stimulus deprivation
amblyopia lead to elongation of the
eye (Wiesel & Raviola 1977; Chalupa
et al. 1982). The elongation effect in
the amblyopic eyes may bring about
more myopic change.
Incidence of stratbismus was 46%
in this study and exotropia was more
common than esotropia. This result
was similar to previous studies and
our study also cannot arrive at a con-
clusion regarding the importance of
the convergence mechanism in the type
of strabismus in patients with paediat-
ric pseudophakia (Gelbart et al. 1982;
France & Frank 1984; Neely et al.
2005). Compared with the incidence of
strabismus in the general population
(1.34.5%), pseudophakic patients in
this study had a higher frequency of
strabismus (Neely et al. 2005).
Our study showed that 15% and
54% of the patients who achieved
20 40 or better VA in both eyes had
good and moderate binocular func-
tion, respectively. Binocular vision
was present in 24.3% of all patients.
These results are superior to the bin-
ocular function results of Lundvall &
Kugelberg (2002) (18.2%). Choung
et al. (2007) and Kohnen et al. (1999)
reported that 21.4% and 12.5% of
unilateral congenital cataract achieved
a stereopsis of 100 seconds of arc or
better, respectively. As unilateral con-
genital cataract patients have two
amblyogenic factors, pattern vision
deprivation and anisometropia, bilat-
eral congenital cataract patients are
expected to show better binocular
function and stereopsis (Kohnen et al.
1999). Because there are few reported
results regarding stereopsis in bilateral
congenital cataract patients, our
results are thought to be meaningful,
but further studies should be per-
formed in the future.
Postoperative complications in con-
genital cataract surgery include VAO,
secondary glaucoma, brinoid reac-
tions, decentralization of the pupil,
retinal detachment and endophthalm-
itis (Keech et al. 1989). Incidence of
secondary glaucoma and VAO in our
study was 32% and 8%, respectively.
Risk factors for glaucoma after the
operation of the congenital cataract
are microphthalmos and early cataract
surgery (Asrani et al. 2000; Byrne
et al. 2000). The severe inammatory
response after congenital cataract sur-
gery in early age can induce adhesion
of the angle (Keech et al. 1989). Sev-
eral authors have noted a low inci-
dence of glaucoma in children with
pseudophakic eyes, the implication
being that pseudophakia in children
somehow protects against glaucoma
(Hiles 1984; Desai & Vasavada 1997;
Asrani et al. 2000; Byrne et al. 2000;
Kirwan et al. 2009). These results
were explained with the theory that
IOL implantation can support the
structure of the trabecular meshwork
and prevent toxic material of the vit-
reous from directly contacting the tra-
becular meshwork and subsequently
inducing glaucoma (Catalano et al.
1991). Glaucoma incidence in our
study was slightly high compared to
other studies (Golub et al. 2006; Bill-
son et al. 2007; Kirwan et al. 2009).
We cannot explain theses phenome-
non, but the long-term follow-up per-
iod may elevate glaucoma incidence.
Because complicated surgical proce-
dures, including IOL manipulation at
an early age, and the long mainte-
nance of the aphakic state may be
causes for secondary glaucoma, pri-
mary aphakia and secondary IOL
implantation around 2 years may con-
tribute to lowering glaucoma inci-
dence. Posterior capsulectomy and
anterior vitrectomy in congenital cata-
ract surgery remarkably lowers the
incidence of PCO (Caporossi et al.
1990). Resultingly, the incidence of
PCO in our study was low as
expected. There were no other postop-
erative complications except band ker-
atopathy and scleromalacia. But
several studies concerning early pri-
mary IOL implantation demonstrated
various postoperative complications
(VAO, corectopia, pupillary mem-
brane formation, retinal detachment
and endophthalmitis) and required
additional surgeries (Buckley et al.
1999; Autrata et al. 2005; Gouws
et al. 2006; Lundvall & Zetterstro m
2006). The low incidence of postoper-
ative complications found in our study
compared to that in early primary
IOL implantation patients appear to
show the superiority of the primary
aphakia, aphakic glasses, and second-
ary IOL implantation procedure.
Contact lenses offer several advan-
tages over spectacles in paediatric age
group, but the patients using contact
lenses showed poorer compliance than
patients using aphakic glasses and the
parents of patients complained con-
tact lens wearing in Korea. So, we
have used aphakic glasses for visual
rehabilitation. From this study, we
think that wearing aphakic glasses can
be good method for postoperative
visual rehabilitation in bilateral con-
genital cataract.
In conclusion, satisfactory BCVA
and binocular function were achieved
in most otherwise healthy children
with dense bilateral congenital cata-
ract and no posterior segment pathol-
ogy, through early cataract surgery,
aphakic correction and secondary IOL
implantation around 2 years of age.
The occurrence of strabismus and sec-
Acta Ophthalmologica 2012
235
ondary glaucoma needs to be checked
during regular follow-up examina-
tions. We believe that the long-term
follow-up and large sample size of
patients in our study itself carries
strong signicance. Moreover, early
cataract surgery, aphakic glasses, and
secondary IOL implantation around
2 years seems to be appropriate
method in the treatment of the con-
genital cataracts.
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Received on August 16th, 2009.
Accepted on December 20th, 2009.
Correspondence:
Young Suk Yu, MD
Department of Ophthalmology
Seoul National University College of Medicine
28 Yeongun-dong
Chongro-ku
Seoul 110-744
Korea
Tel: + 82 2 2072 2437
Fax: + 82 2 741 3187
E-mail: ysyu@snu.ac.kr
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