Preoperative strabismus points to poor visual outcome after pediatric cataract surgery

April 7, 2008

The presence of preoperative strabismus predicts a poorer visual outcome after cataract surgery with intraocular lens implantation. The absence of strabismus predicts better visual outcome after cataract surgery, said Justin Arbuckle, MD.

The presence of preoperative strabismus predicts a poorer visual outcome after cataract surgerywith IOL implantation. The absence of strabismus predicts better visual outcomeafter cataract surgery, said Justin Arbuckle, MD.

Good visual outcomes are increasingly common among children undergoing cataract surgery.

"Identifying factors that will affect the visual outcomes becomes more important," said Dr.Arbuckle, of the Storm Eye Institute, Charleston, SC. "Patient age when the cataract developsand the amount of time that passes until cataract removal are important prognostic factors toindividual outcomes. However, there are other factors that play important roles. There is aknown association between strabismus and cataracts, in that children with cataract frequentlyhave strabismus and that 50% of children with cataract will develop strabismus at somepoint."

This retrospective case series was designed to assess the impact of preoperative strabismus onvisual outcomes in children undergoing cataract removal. The study included 155 eyes of 155patients, 53.5% of whom had bilateral cataracts. The investigators categorized the final visualoutcomes as excellent, good, fair, and poor.

"Overall, 35% of patients had preoperative strabismus," Dr. Arbuckle said. "In children withstrabismus preoperatively and bilateral cataracts, only about 30% achieved excellent to goodfinal visual acuity compared with about 87% of those without preoperative strabismus."

The same trend was seen in children with unilateral cataracts in that excellent to good visionwas achieved in only about 35% of children with preoperative strabismus and in about 75% ofthose without preoperative strabismus, according to Dr. Arbuckle.

"We believe that recognizing preoperative strabismus aids both the surgeon and the parents withchildren with cataract," he said. "Having prognostic information beforehand facilitatescounseling of the parents. Surgeons may be more aggressive in urging parents to patch the eyeor have the children wear glasses. Some surgeons may even choose to target emmetropia for younghigh-risk infants to achieve immediate and more constant correction."