Congenital cataract surgery in infants with microcornea can deliver favorable long-term visual outcomes, according to a new multicenter Japanese study – although postoperative glaucoma and visual axis opacification remain significant management challenges.
Published in Scientific Reports, the retrospective analysis evaluated 43 eyes from 25 patients who underwent cataract surgery within the first year of life and were followed for more than a decade. The study is among the first to report long-term outcomes in both aphakic and pseudophakic eyes with microcornea, a rare congenital condition characterized by a corneal diameter of less than 10 mm.
Microcornea presents substantial surgical challenges in pediatric cataract management due to limited anterior segment anatomy, shallow chambers, and associated ocular anomalies. Until now, evidence guiding intraocular lens (IOL) implantation in these patients has been sparse.
The cohort underwent surgery at a mean age of 3.3 months and was followed for an average of 13.7 years. Bilateral pseudophakic eyes were found to achieve significantly better corrected distance visual acuity (CDVA) at final follow-up when compared with bilateral aphakic eyes.
Functional vision outcomes were also notable, with 88% of bilateral pseudophakic eyes achieving 20/40 vision or better, compared with 39% in bilateral aphakic eyes. The difference was statistically significant and suggests that carefully selected primary IOL implantation may confer visual advantages in these complex cases.
The study authors attribute some of these favorable outcomes to advances in pediatric cataract surgery techniques and modern hydrophobic acrylic IOL designs. All pseudophakic eyes underwent posterior capsulorhexis and anterior vitrectomy at the time of surgery, with IOLs implanted in the capsular bag.
However, the study also highlights some of the trade-offs associated with different management approaches.
Secondary glaucoma developed in 18.8% of aphakic eyes, while no pseudophakic eyes developed glaucoma during follow-up, although this difference did not reach statistical significance. These findings align with previous reports suggesting that primary IOL implantation may not increase – and may potentially reduce – the risk of aphakic glaucoma.
Importantly, all groups experienced substantial myopic shifts over time, reinforcing the difficulty of predicting refractive development in infant eyes. Anisometropia also progressed in unilateral cases regardless of lens status.
The study’s retrospective design and relatively small subgroup sizes limit definitive conclusions, particularly regarding unilateral disease. Selection bias may also have influenced outcomes, as only patients with at least 10 years of follow-up were included.
Nevertheless, the findings provide rare long-term insight into a highly challenging patient population. The data support the feasibility of primary IOL implantation in selected infants with microcornea while underscoring the need for vigilant, lifelong follow-up.
Ultimately, the study reinforces a familiar theme in pediatric cataract care: successful visual rehabilitation depends not only on surgical intervention, but on careful post-operative management of complications, refractive change, and amblyopia risk over many years.
