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Journal of Current Ophthalmology 27 (2015) 103e109
http://www.journals.elsevier.com/journal-of-current-ophthalmology

Long-term visual outcome of congenital cataract at a Tertiary Referral

Center from 2004 to 2014
Zhale Rajavi a,*, Sara Mokhtari a,b, Hamideh Sabbaghi b,c, Mehdi Yaseri d
a
Imam Hossein Medical Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
b
Department of Optometry, School of Rehabilitation, Shahid Beheshti University of Medical Sciences, Tehran, Iran
c
Ophthalmic Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
d
Department of Epidemiology and Biostatistics, Tehran University of Medical Sciences, Tehran, Iran
Received 2 November 2015; accepted 2 November 2015
Available online 13 January 2016

Abstract

Purpose: To assess the long-term visual acuity (VA) outcome after congenital cataract surgery at Imam Hossein Medical Center (Tertiary
Referral Center) (2004e2014).
Methods: In this descriptive study, records of 120 patients with a history of congenital cataract surgery were studied. Those with traumatic,
metabolic cataract, aged <5 years at the last visit who were not able to respond VA testing accurately and follow-up < 6 months were excluded.
Cases with incomplete files were recalled and reexamined. Finally, the records of 42 patients (71 eyes) were included.
Results: In this study, 20 males and 22 females with a mean age of 11.80 ± 6 years at their last visit were studied. Bilateral and unilateral cataract
was seen in 69% and 31% of cases, respectively. Posterior and anterior subcapsular opacity was the most common (53.70%) and rarest (1.90%)
type of congenital cataract, respectively. The mean age at the time of operation and surgical interval was 65 ± 66.6 (range: 1e200) and
12.9 ± 23.5 (range: 0e96) months, respectively. The most common method of refractive error correction was pseudophakia plus glasses (56.3%)
with the mean best corrected visual acuity (BCVA) of 0.29 ± 0.28 LogMAR., The mean BCVA was 0.7 ± 0.53 LogMAR for aphakic patients
correcting by glasses. In our study, amblyopia (56%), glaucoma (23.90%), and posterior capsular opacity (16.40%) were observed during their
follow-ups on an average of 76 ± 65 months (median: 60, range: 6e240). Unilateral cataract, aphakia, nystagmus, female gender, and strabismus
were risk factors of VA loss.
Conclusion: Based on our results, 56% of cases showed amblyopia. It could be due to late operation (especially in unilateral cases), longer
surgical interval between two eyes, and no compliance of amblyopia therapy. Early detection through screening may reduce the rate of
amblyopia. Refractive errors, visual acuity, amblyopia, glaucoma, posterior capsular opacity, and compliance of amblyopia therapy should be
checked regularly at follow-up visits.
Copyright © 2015, Iranian Society of Ophthalmology. Production and hosting by Elsevier B.V. This is an open access article under the CC BY-
NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/).

Keywords: Congenital cataract surgery; Best corrected visual acuity (BCVA); Complications

Introduction eyes. Otherwise, amblyopia is observed. Therefore, early

detection and surgery as well as follow-up visits have signif-
Visual system is developed in children as long as sharp, icant roles in the restoration of a child's vision in the case of
clear and focused images are formed on the retina of both congenital cataract with significant media opacity.1
There are 200,000 children around the world and 133,000
* Corresponding author. Flat 5, No 6, 3rd Shahrestan, North Pesian. Mog- in developing countries that suffer from blindness due to
haddas Ardebili Ave. Vali-ye-Asr St. Tehran, Postal code: 1986866814, Iran. congenital cataract.2 In general, the prevalence of congenital
Tel.: þ98 9123306590, þ98 21 22170799.
E-mail address: zhalerajavi@gmail.com (Z. Rajavi).
cataract as the most common preventable cause of blindness in
Peer review under responsibility of the Iranian Society of Ophthalmology. childhood has been reported from 1 to 15 per 10,000 children,

http://dx.doi.org/10.1016/j.joco.2015.11.001
2452-2325/Copyright © 2015, Iranian Society of Ophthalmology. Production and hosting by Elsevier B.V. This is an open access article under the CC BY-NC-ND
license (http://creativecommons.org/licenses/by-nc-nd/4.0/).
104 Z. Rajavi et al. / Journal of Current Ophthalmology 27 (2015) 103e109

while it is from 1 to 3 per 10,000 births in developing congenital glaucoma and cataract, and a follow-up of less than
countries.3,4 6 months were excluded. According to our inclusion and
Unfortunately, in many cases, even after early surgery, exclusion criteria, children with lens opacity diagnosed in the
long-term follow-up (at least up to the age of 10) is not first year of life and who were operated before age of 16 years
properly instituted, and varying degrees of amblyopia have were included. In case of incomplete documents, the parents
been reported despite wearing appropriate eye glasses, contact were asked to bring their child for further examination, if it
lenses, or implantation of intra ocular lenses (IOL).5 was not possible the incomplete files were excluded. Finally,
In Birch et al.’s study, the best corrected visual acuity the data of 71 eyes (42 cases) were completed as illustrates on
(BCVA) after congenital cataract surgery was 0.60 LogMAR Fig. 1. The study was approved by the Ethics Committee of
(20/80 Snellen equivalent) or better only in 53% of children the Ophthalmic Research of the Imam Hossein Medical
with the age range of 3e7 years old, which is not considered Center, Tehran, Iran.
an acceptable outcome.5 Tomkins et al. reported BCVA from According to patient documents, data including age, sex,
light perception to 0.20 LogMAR (20/32 Snellen equivalent) laterality, type of cataract, age of operation, surgical interval
with better visual results by early surgery.2 Abdelmoaty et al. between the 2 eyes, accompanying baseline strabismus
studied the records of 100 operated congenital cataract children (>±10pd), different stages of surgical technique (aspiration,
and found BCVA of 0.30 LogMAR (20/40 Snellen equivalent) posterior capsulectomy and anterior vitrectomy), with or
in bilateral cases with the mean age of 8.90 ± 8.70 months and without IOL implantation were recorded.
1.00 LogMAR (20/200 Snellen equivalent) in unilateral cases After cataract surgery, in all cases, refractive error was
with the mean age of 5.75 ± 4.61 months at the time of their measured using retinoscope (HEINE BETA 200; US). VA was
surgery.6 Late surgery and unilateral cataract have been re- estimated according to the age of our cases during their
ported as risk factors of lower post-operative visual acuity, and follow-up visits by red reflex assessment, CSM test, and
posterior capsular opacity, glaucoma, and amblyopia have been Snellen E-test at a 6-m distance through their appropriate
found as the most common post-operative long-term compli- glasses. Only BCVA of  5 years were included in this study.
cations according to different studies.6e8 Stereoacuity was also tested using Titmus Stereoacuity test.
The aim of this study was to determine the long-term visual Slit-lamp examination was performed to rule out any abnor-
outcomes and complications after congenital cataract surgery mality of cornea, pupil, anterior chamber, and other anterior
at Imam Hossein Medical Center, Tehran, Iran during segment components. Intra ocular pressure (IOP) was
2004e2014. measured using applanation Goldmann tonometry or Tonopen
(Reichert TONO-PEN AVIA® Tonometer, Richert Inc.
Methods Depew, NY, USA). Funduscopic examination was performed
using indirect ophthalmoscope (HEINE OMEGA® 500, Ger-
In this descriptive study, the records of 120 children who many) through dilated pupil 45 min after instillation of Tro-
had a history of congenital cataract surgery up to 16 years old picamide 1%.
during the past 10 years were reviewed. The patients who had Functional amblyopia was considered if BCVA of each eye
lens opacities (>1 mm centrally or opacities that interfere with was 0.30 LogMAR (20/40 Snellen equivalent) or worse, or
dilated pupil funduscopic examination9) up to age one year there was a difference of two LogMAR lines between two
were included. Children with mental retardation, less than eyes. Posterior capsular opacity (PCO) was indicated if any
5 years at the last visit that were not able to respond VA central whitening and/or wrinkling of the posterior capsular
testing, traumatic/metabolic/radiation/medications and other lens was found in slit-lamp examination, post-operatively.
types of cataract, ptosis, uncooperative children, combined Glaucoma was considered if (IOP) was measured more than

Fig. 1. Flowchart of our study procedure. MR: mental retardation; yrs: years; n: number.
 Z. Rajavi et al. / Journal of Current Ophthalmology 27 (2015) 103e109 105

20 mmHg under general anesthesia using TONO-PEN or Table 1

Perkins in younger children or by applanation tonometry in Demographic data of our patients.
older cases in addition to signs of optic neuropathy.10 Optic Parameters Value
disc appearance and cup/disc ratio were checked by fundu- Age at the last visit (years) Mean ± SD 11.8 ± 6
scopic examinations. Microphthalmia was considered as axial Median (range) 11 (5e26)
length less than 17 mm up in the first year of age.11 Parental Sex (%) Male 20 (47.6%)
Female 22 (52.4%)
cooperation was defined according to their compliance for at Nystagmus No 36 (85.7%)
least 50% of recommended patching hours by asking them at Yes 6 (14.2%)
follow-up visits.12 Partial compliance was considered if par- Microphthalmia No 63 (88.7%)
ents did not have compliance more than 50% of a day in all Yes 8 (11.3%)
periodic follow-ups. Laterality OD 10 (23.8%)
OS 3 (7.1%)
In all cases who had IOL implantation, the IOL was OU 29 (69.0%)
inserted into the posterior chamber or the capsular bag during Strabismus No 22 (52.3%)
the primary operation in 38 cases or secondary operation in 12 Yes 20 (47.6%)
cases. Furthermore, A-scan ultrasound technique was applied Age of surgery (months) Mean ± SD 65 ± 66.6
regarding ocular axial length measurements for implanted Median (range) 37 (1e200)
3 15 (21.1%)
population. Immediate post-operative hyperopic refraction >3 56 (78.9%)
was considered for IOL power calculation up to age 2 or 3 6 21 (29.6%)
based on handheld keratometry and biometry under general >6 50 (70.4%)
anesthesia before cataract surgery. IOL power calculation in 12 30 (42.3%)
older children who cooperated with these tests before surgery, >12 41 (57.7%)
Surgical Interval (months) Mean ± SD 12.9 ± 23.5
have planned for emmetropia with no anisometropia (less than Median (range) 3 (0e96)
3D) compared to their fellow eyes' refraction. Follow Up (months) Mean ± SD 76 ± 65
Median (range) 60 (6e240)
Statistical analysis OD: oculus dexter; OS: oculus sinister; OU: oculus uterque; SD: standard
deviation.
To describe data, mean, standard deviation, median, range,
frequency, and percentage were used.
Normal distribution of data was checked by Kolmogor- Fig. 2 illustrates the prevalence of different types of
oveSmirnov test and QeQ plot. Spearman correlation was congenital cataract in our participants. In our study, posterior
used to obtain the relation between variables. Generalized and anterior subcapsular cataracts were the most common and
Estimating Equations (GEEs) were used to consider the cor- the least prevalent type of congenital cataracts, respectively.
relation in bilateral cases when comparing the groups. All Table 2 shows various techniques of cataract surgery as
statistical analysis was performed by SPSS software (IBM well as post-operative optical correction. Combined lens
SPSS Statistics, Version 22.0. Armonk, NY: IBM Corp). aspiration (90.1%), posterior capsulectomy (94.4%), and
p-value less than 0.05 was considered statistically significant. anterior vitrectomy (91.5%) were the most common surgical
procedure. IOL was implanted in 76% of children with mean
Results age of 9.1 ± 4.8 (range: 2e24) years at primary surgery and
24% with mean age of 4.3 ± 2.1 years (range: 2e7.75) at
In this study, data of 71 eyes (42 patients) with a history of secondary operation. Post-operatively, in cases with PCO
congenital cataract surgery were analyzed. Of these, 20 chil- (n ¼ 11, 16.40%), posterior capsulotomy was performed in
dren were male and 22 were female with the mean age of significant PCOs by neodymium-doped yttrium aluminium
11.80 ± 6 years (5e26 years) at their last visit. There was no garnet (Nd:YAG laser, n ¼ 2) or surgery (n ¼ 1). The com-
case with a history of exposure to X-ray during the fetal bination of IOL implantation and glasses was the most com-
period, being in incubator, and also having epilepsy during mon method used for correcting refractive errors in 56.30% of
childhood. Among 42 cases, one child had a history of cases. Although amblyopia therapy was recommended in all
mother's smoking, one was premature, and two had a history of cases, only 21.7% followed their patching orders, completely
cataract in their family. There was no post-operative report of and regularly.
anterior capsular opacity or phimosis, but there were two pa- Table 3 shows that maximum value of 0.0 LogMAR BCVA
tients with anterior pupillary membrane formation which was (equal to 20/20) was achieved after IOL implantation. Pe-
removed by surgery. ripheral stereopsis (100e3000 s of arc) was also observed in
As Table 1 shows, 29 (69%) and 13 (31%) children had 23 children.
bilateral and unilateral congenital cataract, respectively. The As Fig. 3 shows, glaucoma (23.90%) was the most common
median age of cataract operation and interval between two long-term surgical complication in this study.
eyes were 3 years and 3 months, respectively. Patients were According to our results, unilateral cataract (p < 0.001),
followed for an average of 76 ± 65 months (median: 60, range: nystagmus (p ¼ 0.007), female gender (p ¼ 0.007), strabismus
6e240). (p ¼ 0.009), and all forms of congenital cataract were risk
106 Z. Rajavi et al. / Journal of Current Ophthalmology 27 (2015) 103e109

Fig. 2. Different types of cataract. Mixed cataract: two or more types of cataract.

Table 2
Surgical and optical managements of congenital cataract in our participants.
Epidemiological characteristics
Parameters Value
There were 29 patients (69%) with bilateral and 13 (31%)
Lensectomy No 7 (9.9%) with unilateral congenital cataract. Lee and Msamati et al. also
Yes 64 (90.1%)
Aspiration No 65 (91.5%)
reported more bilateral cases in their studies.13,14
Yes 6 (8.5%) Sensory strabismus was presented in 47.60% (n ¼ 20) of
Plus P. capsulectomy No 4 (5.6%) our cases, which was in line with the study by Demirkilinc
Yes 67 (94.4%) et al. {59.5% of their cases were strabismic after long-term
Plus Ant. Vitx No 6 (8.5%) (>1 year) follow-up examinations}.15 In fact, ocular devia-
Yes 65 (91.5%)
IOL No 21 (29.6%)
tion represents our failure to restore good post-operative VA.
Yes 50 (70.4%) The most common type of congenital cataract in our study
Primary 38 (76.0%) was PSCO, while in South Korea13 the nuclear cataract was
Secondary 12 (24.0%) the most common type. Genetic factors or demographic
Refractive Correction Glasses 17 (23.9%) characteristics in each region and society may have an effi-
C.Lens 4 (5.6%)
IOL 10 (14.1%)
cient role in this regard.
IOL plus Glasses 40 (56.3%)
Amblyopia No 31 (43.7%) Surgical factors
Yes 40 (56.3%)
Compliance of amblyopia therapy No 20 (49.3%) The mean age of surgery in our cases was 65 ± 66.60
Partial 12 (29.0%)
Yes 2 (21.7%)
months (median: 37, range: 1 to 288), while in the studies of
the UK,7,16 China,8 Ethiopia,2 and Kuwait,6 the children were
ECCE: extra capsular cataract extraction; P: posterior; Ant: anterior; Vitx:
vitrectomy.
operated at the mean age of 12 months, 8.7 weeks, 5.6 months,
IOL: intra ocular lens; C.Lens: contact lens; Phaco: phacoemulsification; ASP: 7.21 years, and 12 months, respectively. Our mean age of
aspiration. surgery was closer to the results from Ethiopia than other
countries. Based on the above reports, it should be noted that
factors of VA loss. Zonular cataract had better visual outcomes the diagnosis and surgery of congenital cataract were unfor-
(p ¼ 0.048, Table 4). tunately more delayed in some developing countries compared
to developed countries. The reason could be due to late
Discussion diagnosis and therefore late surgery, less severity or peripheral
lens opacity with acceptable visual acuity, unavailable sub-
In the present study, 71 eyes (42 cases) with a history of specialty of pediatric ophthalmologist in the rural regions,
congenital cataract surgery were included. Their mean age at poor economic status, or a combination of some the above
the last visit was 11.80 ± 6 years old. Long-term BCVA was mentioned etiologies.
0.29 ± 0.28 LogMAR in cases with IOL, 0.70 ± 0.53 Log- Better visual acuity was achieved among children who had
MAR in cases corrected with glasses and 0.37 ± 0.39 Log- surgery at less than 6 months (0.49 ± 0.41 LogMAR)
MAR in cases with IOL plus glasses. compared to older ones (0.78 ± 0.60 LogMAR) in our study.
 Z. Rajavi et al. / Journal of Current Ophthalmology 27 (2015) 103e109 107

Table 3
Visual and refractive outcomes of our participants.
Parameters p
BCVA (LogMAR) Total Mean ± SD 0.46 ± 0.43
Median (range) 0.3 (0e1.8)
Correction Glasses Mean ± SD 0.7 ± 0.53 0.190b
Median (range) 0.6 (0.1e1.7)
C.Lens Mean ± SD 0.7 ± 0
Median (range) 0.7 (0.7e0.7)
IOL Mean ± SD 0.29 ± 0.28
Median (range) 0.26 (0e1)
IOL þ Glasses Mean ± SD 0.37 ± 0.39
Median (range) 0.22 (0e1.8)
SE (D) IOL No Mean ± SD 11.76 ± 3.54 <0.001a
Median (range) 11.13 (6.75e20)
Yes Mean ± SD 1.55 ± 1.91
Median (range) 1 (6.5 to 1.25)
Stereopsis (sec/arc) No 19 (45.2%)
Yes 23 (54.8%)
Value Mean ± SD 681 ± 960
Median (range) 400 (30e3000)
BCVA: best corrected visual acuity; LogMAR: logarithm minimum angle of resolution; C.Lens: contact lens; IOL: intra ocular lens; Sph: spherical; SE: spherical
equivalent; sec: second.
a
Based on ManneWhitney test.
b
Based on KruskaleWallis test.

Fig. 3. Post-operative complications of our participants. PCO: Posterior Capsular Opacity; Vit: vitreous; IOL: Intra Ocular Lens.

Although this difference was noticeable clinically, it was not with secondary implantation due to age limitation (<2 years
statistically significant (Table 4). Studies of Ethiopia,2 Brit- in bilateral and <1 year for unilateral cases), deep ambly-
ain,16 and China8 found statistically better visual outcomes in opia secondary to retinopathy of prematurity (ROP), or
younger surgical ages. eccentric fixation (EF), uveitis, glaucoma, fundus lesion, and
The mean surgical interval of two eyes in this study was ocular anomalies like microphthalmia. Magli et al.17 also
12.9 ± 23.50 months (median: 3, range: 0 to 96), and it was implanted their cases in primary or secondary operations as
longer compared to Jain et al.'s study16 with the mean surgical well.
interval of 3.80 days. The reason could be due to unequal lens
opacities in both eyes or poor socioeconomic status of child's Correction of aphakia and visual outcomes
families.
In our study, the common method of congenital cataract To correct the residual refractive errors after congenital
surgery was lensectomy combined with posterior capsu- cataract surgery with IOL implantation (70.40%), the glasses
lectomy and anterior vitrectomy with or without IOL im- were needed in 40 cases (56.30%). Only 4 of 13 unilateral
plantation, as others.8,13 cataract cases were corrected by contact lenses. It seems some
IOL implantation was performed in 50 eyes (70.40%), contact lens problems such as infection, loss, and cost made its
38 cases of which (76%) were implanted at the same oper- usage limited, except in some unilateral cases who have been
ation (primary implantation), and 12 cases of which (24%) operated in the early infancy period.
108 Z. Rajavi et al. / Journal of Current Ophthalmology 27 (2015) 103e109

Table 4 examination can be also considered useful evidence in this

Risk factors of post-operative best corrected visual acuity. regard. Eriksen et al.18 indicated the efficient role of parents in
Best corrected visual acuity amblyopia therapy, but Ye et al.8 found little effect of the
Parameters Mean ± SD Median (range) pa parental cooperation in this regard, similar to ours.
Sex Male 0.31 ± 0.33 0.22 (0e1.8) 0.007 Unilateral cataract, nystagmus, female gender, strabismus,
Female 0.59 ± 0.48 0.52 (0e1.7) and all types of congenital cataract, except zonular, were
Laterality OD 0.94 ± 0.49 0.7 (0.22e1.8) <0.001 considered as the risk factors of our post-operative BCVA.
OS 0.93 ± 0.21 1 (0.7e1.1) According to other studies, lack of parental compliance for
OU 0.35 ± 0.36 0.3 (0e1.7)
Nystagmus No 0.42 ± 0.45 0.3 (0e1.8) 0.007
amblyopia therapy,7 longer surgical interval,16 and delayed
Yes 0.66 ± 0.22 0.7 (0.22e1) surgery18 were also reported as the risk factors of the post-
Strabismus No 0.3 ± 0.24 0.26 (0e1) 0.009 operative BCVA.
Yes 0.63 ± 0.53 0.7 (0e1.8) The mean follow-up of our study was 5 years (6e240
Posterior subcapsular No 0.34 ± 0.25 0.3 (0e1) 0.364 months), which was comparable to other studies.8,16,19
cataract Yes 0.56 ± 0.53 0.3 (0.05e1.7)
Anterior subcapsular No 0.44 ± 0.43 0.3 (0e1.7) 0.197
cataract Yes 1 ± 0.0 1 (1e1) Complications
Zonular cataract No 0.49 ± 0.45 0.3 (0e1.7) 0.048
Yes 0.17 ± 0.13 0.16 (0e0.4) Our long-term complications were PCO (16.40%) and
Nuclear cataract No 0.44 ± 0.45 0.3 (0e1.8) 0.962 glaucoma (23.90%) as reported in other publications like Astle
Yes 0.48 ± 0.53 0.3 (0e1.7)
Total cataract No 0.43 ± 0.41 0.3 (0e1.7) 0.153
et al.’s study with 22.70% PCO as a common surgical
Yes 0.62 ± 0.53 0.3 (0.22e1.7) complication and Abdelmoaty et al.'s, with 4% PCO and 2%
Mixed cataract No 0.43 ± 0.32 0.3 (0e1.2) 0.780 glaucoma, postoperatively.6,19
Yes 0.53 ± 0.53 0.3 (0.05e1.7)
Compliance No 0.45 ± 0.4 0.3 (0e1.7) 0.934 Limitations of the study
Yes/No 0.34 ± 0.22 0.3 (0e0.9)
Yes 0.47 ± 0.49 0.3 (0e1.8)
Age of surgery 3 0.56 ± 0.44 0.3 (0.1e1.7) The study design (existing data) was one of our limitations.
(months) >3 0.32 ± 0.29 0.25 (0e0.7) We tried to overcome it by completing some files through
6 0.49 ± 0.41 0.3 (0e1.7) 0.206 calling and asking some questions and recruitment of some
>6 0.78 ± 0.60 0.7 (0.1e1.7) cases for complementary examinations. A small sample size
12 0.78 ± 0.60 0.7 (0.1e1.7)
>12 0.37 ± 0.37 0.22 (0e1.8)
was another limitation of our study. It was due to our limiting
Glaucoma No 0.46 ± 0.46 0.3 (0e1.8) 0.984 inclusion criteria since we wanted to prevent the effect of other
Yes 0.44 ± 0.34 0.52 (0e1.1) factors on final VA to increase internal validity of our study.
PCO No 0.42 ± 0.37 0.3 (0e1.8) 0.992 In the current study, late diagnosis, late operation, long
Yes 0.43 ± 0.49 0.3 (0e1.7) surgical interval, short-term post-operative follow-up, and
PCO: posterior capsular opacity; IOL: intra ocular lens; SD: standard devia- some long-term complications are major findings.
tion; OD: oculus dexter; OS: oculus sinister; OU: oculus uterque. Based on our results, 56% of our cases showed post-
a
Based on ManneWhitney or KruskaleWallis test, whenever appropriate.
We found no statistical relation between the surgical interval of two eyes and
operative amblyopia. It could be due to late operation (espe-
final BCVA (r ¼ 0.166, p ¼ 0.218). cially in unilateral cases), longer surgical interval between
two eyes, and no compliance of amblyopia therapy. Early
detection through screening may reduce the rate of amblyopia.
The mean BCVA after IOL implantation was 0.29 ± 0.28 All practitioners should check refractive errors, visual acuity,
LogMAR. Tomkins et al.2 shows the good BCVA after IOL amblyopia, glaucoma, posterior capsular opacity, and
implantation as well (92% of their patients presented final compliance of amblyopia therapy in each post-operative visit.
BCVA of 0.20 LogMAR).
In our study, the mean BCVA of bilateral congenital cata- Conflict of interest
ract was more than unilateral cases (p < 0.001) as indicated in
studies of Chak7 and Abdelmoaty et al.,6 and there was better The authors have no conflict of interest with the subject
BCVA in males compared to females (p ¼ 0.007). Eriksen matter of this manuscript.
et al.18 reported that males had better prognosis for good
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