OUTCOME AFTER VERY EARLY TREATMENT OF DENSE CONGENITAL UNILATERAL CATARACT

Purpose. To evaluate whether very early treatment for congenital unila teral cataract results in better long-term functional outcomes, gratin g acuity, contrast sensitivity, recognition acuity, and random-dot ste reoacuity were evaluated in two groups of children. Methods. Grating a cuity and contrast sensitivity data were obtained with standard forced -choice protocols. Stereoacuity data were obtained both in a forced-ch oice laboratory protocol and by the Randot test. Results. Immediately after treatment, both the very early (1 to 6 weeks; n = 8) and early ( 2 to 8 months; n = 6) treatment groups showed a 0.3 log unit grating a cuity deficit in the aphakic eye. Grating acuity in the early group sh owed some improvement with age but reached a plateau of 0.75 logMAR at 18 to 24 months; the very early group showed more improvement and rea ched a plateau of 0.22 logMAR at 37 to 48 months. At 5 to 8 years of a ge, aphakic eyes of the very early group had significantly better cont rast sensitivity and recognition acuity than the aphakic eyes of the e arly group. Overall, grating acuity deficits during years 2 through 5 were significantly correlated with contrast sensitivity and recognitio n acuity outcomes measured at 5 to 8 years of age. No deficits in grat ing acuity, contrast sensitivity, or recognition acuity were found for phakic fellow eyes in either group. Three children in the very early treatment group (37.5%) were orthotropic and demonstrated gross random -dot stereopsis; one child in the early group was orthotropic but none of these children demonstrated random-dot stereopsis. Conclusions. Th ese results suggest that treatment initiated at 1 to 6 weeks of age ma ximizes the opportunity for normal or near-normal visual development o f a congenitally cataractous eye with little or no risk to the phakic fellow eye.