Visual impairment and delay in presentation for surgery in chinese pediatric patients with cataract

Abstract

Purpose: To report visual impairment and blindness and delay in presentation for surgery in Chinese pediatric patients with cataract.

Design: Retrospective case series.

Participants: A total of 196 children (309 eyes) with congenital or developmental cataract.

Methods: Surgery was performed in all patients. Visual impairment and blindness were defined as best-corrected visual acuity < 20/60. The characteristics, visual acuity, and time delay to surgery of these children were evaluated.

Main outcome measures: Incidence of visual impairment and blindness, ages at disease recognition and at surgery, and duration of delay in presentation for surgery.

Results: Visual acuity was 20/25 or better in 22 eyes (7.1%), between 20/25 and 20/40 in 72 eyes (23.3%), and between 20/40 and 20/60 in 87 eyes (28.2%). Visual impairment and blindness occurred in 41.4% of eyes, 52.0% of patients, 35.4% of patients with bilateral cataract, and 74.7% of patients with unilateral cataract. The frequency of visual impairment and blindness in eyes with combined nystagmus, combined strabismus, total cataract, nuclear cataract, and posterior polar cataract was 84.4%, 75%, 63.8%, 48%, and 48.3%, respectively. Severe postoperative complications resulted in 14.8% of visual impairment and blindness. The mean ages at disease recognition and at surgery were 22.6 ± 30.4 months and 68.3 ± 40.0 months, respectively. The mean delay of presentation for surgery was 49.6 ± 39.8 months in all patients and 35.7 ± 32.2 months in the patients with congenital cataract. The disease was recognized within 6 months of age in 46 children (40.7%) with bilateral cataract and 10 children (12.0%) with unilateral cataract. Among these children, only 18 (15.9%) with bilateral cataract and 1 (1.2%) with unilateral cataract underwent surgery between 3 and 6 months of age. No patients received surgical intervention within 3 months.

Conclusions: Severe visual impairment is common in pediatric patients with cataract in China. Delayed presentation to the hospital and late surgical treatment are the major reasons and deserve greater attention.