Three Cases of Secondary Fungal Infection in Herpes Simplex Keratitis

PURPOSE: To report several cases of secondary infection by fungus in herpes simplex keratitis. CASE SUMMARY: A retrospective chart review was performed on 3 eyes of 3 patients who were without improvement and diagnosed with fungal keratitis by smear and culture on prior presentation with herpetic keratitis. Two cases were diagnosed with fungal keratitis, based on the results of culture. Fungal keratitis by Candida albicans was improved with antifungal agents, but a case caused by Fusarium species was more aggravated, regardless of antifungal agents. One case was improved by antifungal medications, which was diagnosed with fungal keratitis by the fungal hyphae manifestation on KOH preparation. CONCLUSIONS: Secondary microbial infection should be considered, when the lesion had no improvement with antiviral agents in herpetic keratitis.

Effect of Topical 0.05% Cyclosporine A in Dry Eye Associated With Thyroid Ophthalmopathy

PURPOSE: The present study was performed to evaluate the changes in tear film and ocular surface parameters after using sodium hyaluronate (SH) 0.1% alone or in combination with cyclosporine A (CsA) 0.05% in patients with thyroid-associated ophthalmopathy accompanied by dry eye. METHODS: A total of 72 eyes from 36 patients were divided into two groups; 36 eyes of 18 patients were treated with 0.1% SH alone (group 1), and 36 eyes of 18 patients were treated with SH 0.1% and CsA 0.05% (group 2). Tear break-up time (BUT), basal tear secretion test (BST), tear clearance rate (TCR), fluorescein staining (FS) and corneal sensitivity test (CST) were evaluated at pre-treatment and one, three and six months post-treatment. Conjunctival impression cytology was performed and tear CXCL11 (Chemokine (C-X-C motif) ligand) levels were measured pre-treatment and three months post-treatment. RESULTS: BUT, BST, TCR, KEP and CST were significantly improved at six months in group 1 (p < 0.05) and at three months in group 2 (p < 0.05). The degree of conjunctival squamous cell metaplasia, goblet cell density and tear CXCL11 levels were significantly changed at three months in group 2 (p < 0.05). However, there were no significant changes in group 1 after 3 months. CONCLUSIONS: Combined use of topical 0.1% SH and 0.05% CsA can result in early improvement in tear films and ocular surface parameters in patients with thyroid-associated ophthalmopathy accompanied by dry eye.

Neurotoxicity Screening in a Multipotent Neural Stem Cell Line Established from the Mouse Brain

Neural stem cells (NSCs) have mainly been applied to neurodegeneration in some medically intractable neurologic diseases. In this study, we established a novel NSC line and investigated the cytotoxic responses of NSCs to exogenous neurotoxicants, glutamates and reactive oxygen species (ROS). A multipotent NSC line, B2A1 cells, was established from long-term primary cultures of oligodendrocyte-enriched cells from an adult BALB/c mouse brain. B2A1 cells could be differentiated into neuronal, astrocytic and oligodendroglial lineages. The cells also expressed genotypic mRNA messages for both neural progenitor cells and differentiated neuronoglial cells. B2A1 cells treated with hydrogen peroxide and L-buthionine-(S,R)-sulfoximine underwent 30-40% cell death, while B2A1 cells treated with glutamate and kainate showed 25-35% cell death. Cytopathologic changes consisting of swollen cell bodies, loss of cytoplasmic processes, and nuclear chromatin disintegration, developed after exposure to both ROS and excitotoxic chemicals. These results suggest that B2A1 cells may be useful in the study of NSC biology and may constitute an effective neurotoxicity screening system for ROS and excitotoxic chemicals.

The Relationship Between Bagolini Test and Other Sensory Tests and Surgical Outcome of Intermittent Exotropia

PURPOSE: To determine the surgical outcome of intermittent exotropia according to preoperative retinal correspondence with the Bagolini striated glasses test and the relationships between the Worth-4-dot test or stereoacuity with the B-VAT test. METHODS: We analyzed retrospectively preoperative fusion statuses with the Worth-4-dot test, stereoacuity with the B-VAT test and retinal correspondence with the Bagolini striated glasses test to determine any possible relationships with surgical outcome. The surgical outcome and binocular function were further investigated six months postoperatively in 114 patients who had undergone surgery for intermittent exotropia. RESULTS: The surgical outcome according to preoperative fusion status and stereoacuity was not statistically significant(p=0.38, p=0.59). whereas, preoperative retinal correspondence with the Bagolini striated glasses test was statistically significant(p<0.01). More over there was a relationship between retinal correspondence and fusion status or stereoacuity(p<0.01, p<0.01). CONCLUSIONS: The preoperative Bagolini striated glasses test was the factor predicting a favorable surgical outcome and there was a relationship between the preoperative Worth-4-dot test and the B-VAT test.

Long-Term Results of Descemet's Stripping Automated Endothelial Keratoplasty in Korea

PURPOSE: To evaluate the long-term results of Descemet's stripping automated endothelial keratoplasty in Korea (DSAEK). METHODS: Seven patients with bullous keratopathy who underwent DSAEK and who were followed-up for more than 18 months were reviewed retrospectively. Best corrected visual acuity, refraction, corneal thickness, and endothelial cell count were examined before and after surgery. RESULTS: The mean follow-up period was 19.9 +/- 2.9 months (18 to 24 months), and the mean age was 61.42 +/- 10.13 years (46 to 76 years). Six patients (85.7%) showed successful results after surgery. Best corrected visual acuity (logMAR) was significantly improved from 1.62 (median) to 1.15 (median) (p = 0.027) at one month after surgery and was maintained until the final follow-up period. There were no statistical differences in spherical ametropia or astigmatism before or 18 months after the operation. Graft failure was observed in one case, in which penetrating keratoplasty was performed 12 months after DSAEK. CONCLUSIONS: Long term results of DSAEK showed fast visual recovery, low ametropia and astigmatism. DSAEK may be a good option for the surgical management of corneal endothelial disease.

Age-related Clinical Analysis of Infectious Keratitis in Two Tertiary Centers

PURPOSE: To evaluate the age-related risk factors, clinical manifestations, and prognosis in infectious keratitis. METHODS: Records of patients with infectious keratitis who visited one of the two tertiary medical centers at Jeolla-do from January 2000 to December 2007 were reviewed. Risk factors depending on patient age distribution standardized over and under the age of 60 were reviewed retrospectively by analyzing sex, age, previous history of trauma, systemic disease, previous ocular disease, causative organism and treatment. RESULTS: A total of 757 patients (757 eyes) visited either one of the two tertiary medical centers. The mean age was 58.2+/-18.0 (4 to 93) years, and patients included 437 males (57.7%), and 320 females (42.3%). The most common risk factor among all age groups was trauma, especially due to vegetable matter. The second most frequent risk factor among the younger patients was contact lens use (19.2%), and common risk factors among the elderly were previous ocular disease (20.0%), systemic disease (15.5%), and ocular surgery (9.7%). The most prevalent causative organisms among all age groups were Gram-positive bacteria, in particular Staphylococcus epidermidis. Elderly patients had a higher frequency of corneal perforation than did younger patients. In addition, elderly patients had a worse prognosis and more often required surgical treatment. CONCLUSIONS: Infectious keratitis has more severe clinical manifestations and complications and a worse prognosis in elderly than in younger patients. Elderly patients have more diverse risk factors. Prevention should aim at avoiding ocular trauma, especially by vegetable matter, and at controlling ocular surface diseases, such as exposure keratitis and bullous keratopathy.

The Changes of Corneal Astigmatism and Refraction After Horizontal Rectus Muscle Surgery in Intermittent Exotropia

PURPOSE: To investigate changes in corneal astigmatism and refractive power in intermittent exotropia after lateral rectus recession with or without medial rectus resection. METHODS: We compared visual acuity, spherical equivalent, refractive power, astigmatism from cycloplegic refraction, and Orbscan corneal topography in two groups consisting of 40 eyes from 20 patients who underwent bilateral lateral rectus recession (Group 1) and 33 eyes from 33 patients who underwent monocular medial rectus resection with lateral rectus recession (Group 2) immediately preoperatively and at 1 and 4 weeks postoperatively. RESULTS: In Group 1, the refractive power changed +0.12 D on average in the horizontal median and -0.08 D on average in the vertical median at 1 week postoperatively. The refractive power changed +0.07 D on average in the horizontal median and -0.04 D on average in the vertical median at 4 weeks postoperatively. No significant change in the corneal astigmatic axis was detected. In Group 2, the refractive power changed +0.4 D on average in the horizontal median and -0.19D on average in the vertical median, and the corneal astigmatic axis significantly shifted by +0.51 D in the 'with-the-rule astigmatism' direction at 1 week postoperatively (p=0.02). However, the refractive power changed +0.2 D on average in the horizontal median and -0.09 D on average in the vertical median, and the corneal astigmatic axis changed +0.2 D at 4 weeks postoperatively, although these values were not statistically significant. CONCLUSIONS: Postoperative refractive power and corneal astigmatism did not change significantly, as compared to preoperative values, at 4 weeks postoperatively in the lateral rectus recession-only or medial-and-lateral rectus recession group.

Bilateral Medial Rectus Recession Posterior to the Functional Equator in Esotropia Over 40 Prism Diopters

PURPOSE: To investigate bilateral medial rectus recession by considering functional equator as a surgical guideline in esotropia over 40 prism diopters (PD). METHODS: Forty-one patients who underwent bilateral medial rectus recession, and were followed-up for more than 12 months, were reviewed. The success rate was compared between group 1 and group 2, which were divided to recession site from the functional equator posterior, and also between the hyperopia group and myopia group according to refraction. RESULTS: According to preoperative deviation angle, 21 patients underwent recession to less than 10 mm posterior to the functional equator (group 1) and 20 patients had recession to 1.5 mm to 2.0 mm posterior to the functional equator (group 2). No significant difference in success rate between group 1 (71.4%) and group 2 (75.0%) was detected at the last follow-up. When divided into a hyperopia group (26 patients) and myopia group (15 patients), the success rate in the myopia group was higher than in the hyperopia group, as observed at the last follow-up, but the difference was not significant. There was 1 case of overcorrection in each group. CONCLUSIONS: A successful outcome was achieved in 30 patients (73.2%), and overcorrection in 2 patients (4.9%) when recessed to 2.0 mm posterior to functional posterior in esotropia over 40PD.

Comparison of Visual Function Among Aspheric Intraocular Lenses

PURPOSE:To compare the visual function among 3 aspheric intraocular lenses (IOLs) after cataract surgery. METHODS: A prospective analysis among 70 eyes of 68 patients who had undergone phacoemulsification and implantation of aspheric IOLs (Acrysof IQ, 30 eyes; Tecnis ZA9003, 20 eyes; Akreos Adapt-AO, 20 eyes) was performed. The best corrected visual acuity (BCVA), refraction, coma, trefoil, spherical aberration, root-mean-square (RMS), contrast sensitivity test, satisfaction and glare was evaluated during the follow-up period of 3 months. RESULTS: There were no significant differences in BCVA, satisfaction, glare, coma, trefoil, RMS and contrast sensitivity test among the 3 aspheric IOLs. Spherical aberration in Akreos Adapt-AO (0.04+/-0.05 microm) was higher compared with Acrysof IQ (0.03+/-0.04 microm) and Tecnis ZA9003 (0.11+/-0.03 microm)(p<0.01). The predictability of postoperative spherical equivalent in the Akreos Adapt-AO group (-0.57+/-0.22D) represented a statistically significant myopic refractive error compared with the Acrysof IQ (0.01+/-0.77D) and the Tecnis ZA9003 (-0.20+/-0.71D) groups (p=0.04). CONCLUSIONS: There were no significant differences in visual function except spherical aberration, which was highest in the Akreos Adapt-AO group.

A Case of Rectus Muscle Transposition With Silicone Band in Strabismus Fixus With High Myopia

PURPOSE: To present a surgical result of rectus muscle transposition with silicone band without suture on the sclera in strabismus fixus with high myopia. CASE SUMMARY: A 73-year-old female patient with a 20-year history of bilateral esotropia and hypotropia visited our clinic. The patient`s right eye was aphakic because crystalline lens removal was performed 17 years earlier and the left eye was phthisical after retinal detachment, due to high myopia. Ocular movements in both eyes were severely restricted in all directions with the cornea barely visible. Ultrasound examination revealed posterior staphyloma of the retina. The axial length measurement was 32 mm in the right eye, and could not be measured in the left eye. Posterior tenon fixation of the medial rectus and inferior rectus muscle tendon was performed, in addition, fixation of the lateral half of the superior rectus and superior half of the lateral rectus muscle on the silicone band 10 mm posterior to each muscle's scleral insertion as a transposition procedure was performed. At 6 months postoperatively, there was no residual esotropia or hypotropia. The right eye maintained a gaze limitation but improved abduction and supraduction. CONCLUSIONS: In strabismus fixus with high myopia, posterior tenon fixation and muscle transposition with silicone band is an effective method without complication.

Anomalous Scleral Insertion of Superior Oblique in Axenfeld-Rieger Syndrome

Axenfeld-Rieger syndrome (ARS) is associated with ocular and systemic anomalies. PITX2 is known to be a major controlling gene in the pathogenesis of ARS and is associated with differentiation in both the neural crest and mesoderm during eye development. A 4-year-old girl with bilateral ARS had 20 prism diopters (PD) of exotropia with 30PD of A- pattern deviation, more than 20PD of dissociated vertical deviation (DVD), and severe superior oblique overaction (SOOA). During surgery we observed that the SO inserted more posteriorly than normal. We believe this finding is one of the abnormal manifestations of the development of the extraocular muscles in ARS.

Comparison of Long-Term Results between One-piece and Three-piece Acrylate Intraocular Lens

PURPOSE: To compare the long-term clinical results of one-piece Acrysof(R) (SA60AT) hydrophobic acrylic intraocular lens (IOL) implantation compared with implantation of three-piece Acrysof(R) (MA60BM) hydrophobic acrylic IOL. METHODS: We retrospectively analyzed each 50 eyes of 50 patients underwent MA60BM or SA60AT IOL implantation and followed for at least 6 months. RESULTS: Final visual acuity of 0.5 or better was 38 eyes (76%) and 0.8 or better was 20 eyes (40%) in the SA60AT group. In the MA60BM group, it was 41 eyes (82%) and 23 eyes (46%) respectively. There were no significantly differences in predictability, intraocular pressure, endothelial cell density, astigmatism, and incidence of posterior capsule opacification between the two groups. Spherical equivalent at postoperative 1 week was -0.50+/-0.95D in SA60AT group and was -0.31+/-0.88D in MA60BM group (P=0.04). However, there was no significant difference between the two groups during follow up period. In MA60BM group, anterior chamber depth (P=0.02) and distance between iris and IOL (P=0.04) reduced significantly during the first postoperative month. CONCLUSIONS: Early postoperative axial displacement and changes in spherical equivalent can be occurred in MA60BM group. However there was no difference in long-term clinical results between SA60AT and MA60BM groups.

Clinical Results between Scleral Buckling and Vitrectomy in Pseudophakic Retinal Detachment with Intact Posterior Capsule

PURPOSE: To compare the clinical outcomes between scleral buckling and vitrectomy in the primary management of pseudophakic retinal detachment with an intact posterior capsule. METHODS: The medical records of 63 eyes that underwent scleral buckling (36 eyes) or vitrectomy (27 eyes) as a primary operation of uncomplicated pseudophakic retinal detachment with intact posterior capsules with a follow-up of more than one year were retrospectively reviewed from 2000 to 2005. We compared the clinical outcomes using anatomical and functional success rates at postoperative one year. Anatomical success was defined by a reattachment rate and functional success was measured by a change of more than 0.3 logMAR. RESULTS: Anatomical success rates were 86% in the scleral buckling and 82% in the vitrectomy, respectively (p=0.837). Functional success rates were 81% in the scleral buckling and 70% in the vitrectomy, respectively (p=0.065). There were no significant differences of anatomical and functional success rates according to each surgical procedure. CONCLUSIONS: Either scleral buckling or vitrectomy may be chosen as a primary operation in the management of pseudophakic retinal detachment with intact posterior capsule.

Long-term Follow-up Results of Partially Accommodative Esotropia After Near Geared Standard Surgery

PURPOSE: To analyze the long-term outcome of near geared standard surgery with full hyperopic correction for partially accommodative esotropia. METHODS: The medical records of a total of 24 patients with partially accommodative esotorpia, who had undergone bilateral or unilateral medial rectus recession were retrospectively reviewed. The amount of medial rectus recession was measured based on the near deviation after full hyperopic correction. During the follow-up period the changes of refractive error and angle of deviation were evaluated, and the titmus test and Worth 4-Dot test were performed. RESULTS: The mean ages were 36.63+/-13.38 months (14~59 months) at the time of wearing glasses and 61.25+/-25.55 months (25~132 months) at the time of operation. The average follow-up period was 59.67+/-32.12 months (18~120 months) and preoperative refractive errors were +3.93+/-1.73 D sph and refractive errors at final visit were +3.64+/-2.07 D sph (P=0.53). The mean amount of esodeviation were 26.08+/-8.13PD and 4.25+/-6.63PD for pre- and post-operatively respectively. Nineteen patients showed postoperative deviation of 10PD or less, one patient was overcorrected, and four patients were undercorrected. Worth 4-Dot test resulted in a fusion response at near and far in one patient preoperatively and in 17 patients postoperatively (P=0.30). A titmus stereotest of less than 100 seconds of arc resulted in 1 of 7 patients and 6 of 14 patients at the time of preoperation and postoperation each (P=0.34). The results were not statistically significant. Four of ten high hyperopic patients (> or = +4.00 diopter) had under- or over-correction (P=0.12), though it was not statistically significant. There were no significant differences in combined conditions. CONCLUSIONS: Near geared standard surgery with full hyperopic correction in partially accommodative esotropia patients gave a good surgical result for patients in the mean follow-up duration of 59.67 months.

Clinical Features of Refractive Accommodative Esotropia: Long-term Study

PURPOSE: To analyze the long-term clinical features and functional outcomes of refractive accommodative esotropia. METHODS: Initial and final age, cycloplegic refraction, distance and near deviation with and without correction, stereoacuity and incidence of amblyopia were evaluated in 45 patients with accommodative esotropia. RESULTS: The follow-up duration was 65.77+/-43.98 (6~151) months, and the mean age was 4.02+/-1.97 and 9.42+/-3.77 years at the first and final visits, respectively. The cycloplegic refraction was decreased from 5.16+/-1.92 diopters (D) to 4.41+/-1.83D, averaging -0.09+/-0.40D annually (P<0.01). Of these hyperopic eyes, 55 (61.1%) experienced a decrease, 22 (24.4%) an increase, and 5 (5.6%) showed no changes. From 5 (31.2%) to 12 (75.0%) of 16 patients had a stereoacuity of 100 sec/arc or better (p<0.01). Fusion was achieved in 14 (87.5%) at the final visit, up from 11 (68.8%) at the first visit (P=0.39); 23 (51.1%) of the patients were amblyopic; and anisometropia was found in 9 (39.1%) patients. CONCLUSIONS: Patients whose esotropia was corrected with full cycloplegic hyperopic correction show decreased longitudinal changes in spherical equivalent refractive error with a time course and have excellent binocularity outcomes.

Effect of Tectonic Penetrating Keratoplasty for Impending Perforation Due to Infectious Corneal Ulcer

PURPOSE: To investigate the effect of tectonic penetrating keratoplasty for the treatment of impending perforations caused by infectious corneal ulcers. METHODS: We analyzed preoperative and postoperative visual acuity, lesion location and size, graft size, postoperative outcome, and complications in 19 patients (19 eyes) with impending perforations due to infectious corneal ulcers. All patients underwent tectonic penetrating keratoplasty and had a minimum follow-up period of 6 months. RESULTS: In our study, eight eyes (42.1%) had herpes simplex keratitis, 6 eyes (31.6%) had bacterial keratitis, and 5 eyes (26.3%) had fungal keratitis. Twelve eyes had a lesion located in the central cornea, while 7 eyes had a lesion located in the paracentral cornea. Visual acuity improved in 13 eyes (68.4%) and anatomical success was achieved in 16 eyes (84.2%). Three eyes (15.8%) developed a graft melting secondary to rejection. Complications included bullous keratopathy (3 eyes, 15.8%), graft infection (3 eyes, 15.8%), neovascularization (2 eyes, 10.5%), and secondary glaucoma (1 eye, 5.3%). CONCLUSIONS: Tectonic penetrating keratoplasty maintains ocular integrity and effectively treats impending perforations caused by infectious corneal ulcers.

Clinical Aspect and Prognosis of Stenotrophomonas (Xanthomonas) Maltophilia Keratitis

PURPOSE: To investigate the risk factor, clinical manifestations, treatment results, and prognoses in Stenotrophomonas maltophilia keratitis. METHODS: Ten eyes of 10 patients who were diagnosed with, Stenotrophomonas maltophilia by corneal smear and culture were included in this study. Each patient's past history, visual acuity, location and size of ulceration, hypopyon, treatment results and prognosis were analyzed retrospectively. RESULTS: Seven pateints (70.0%) were men, and 3 were women. The mean age was 62.9+/-11.3 years. Only 2 eyes (20.0%) had previous histories of corneal traumas. Polymicrobial infections, including 3 cases infected with Pseudomonas species and 2 cases infected with Fusarium species, were detected in 7 eyes (70.0%). The lesions were located at the corneal center in 6 eyes, and hypopyon was observed in 9 eyes. The average size of ulceration was 28.5+/-19.6 mm2. Seven eyes (70.0%) underwent surgical treatment. The initial visual acuity was less than 0.02 in 9 eyes (90.0%). The final visual acuity improved in 3 eyes (30.0%) and was less than hand movement in 7 eyes (70.0%). CONCLUSIONS: Stenotrophomonas maltophilia keratitis occurs in patients with a compromised ocular surface, is often polymicrobial, and is associated with poor prognoses.

The Effect of Inferior Oblique Muscle Surgery in Congenital Superior Oblique Palsy

PURPOSE: To compare the postoperative results of inferior oblique muscle operation in congenital superior oblique palsy (CSOP) according to the preoperative vertical deviation. METHODS: This study reviewed medical records of 26 patients who were diagnosed as CSOP with the largest vertical deviation at adducted position and incomitant vertical strabismus from May 2003 to April 2004 at hospital. The patients were divided into two groups, the group 1 (18 patients) shows less than 20 prism diopter (PD) vertical deviation at the primary position, the group 2 (10 patients) shows no less than 20 PD vertical deviation at the primary position preoperatively. We performed operation of the inferior oblique muscle (IOM) for both group. We evaluated the surgical effect at the primary position and both lateral gaze after 3 months. and performed reoperation as needed. RESULTS: Mean correction amount of vertical deviation at primary position of two groups were 11.6+/-2.7 PD in the group 1 and 7.4+/-3.5 PD in the group 2. Postoperative vertical deviation was decreased compared to preoperative value and it was statistically significant. But there were statistically significant differences in the corrected amount after inferior oblique muscle operation between two groups at all gazes. Surgical result of group 1 was successful (100%), but in group 2, all failed (100%) and needed reoperation. CONCLUSIONS: This study showed that corrected amount with IOM operation was smaller in CSOP with no less than 20 PD vertical deviation at primary position and incomitant vertical strabismus. It may be taken into consideration when operation for rectus and oblique musle were performed simultaneously in CSOP.

The Surgical Effect of Posterior Fixation Suture in Incomitant Strabismus

PURPOSE: To know the surgical effect and the indication of posterior fixation suture in incomitant strabismus. METHODS: From January 2003 to October 2004, posterior fixation sutures were used in five patients with strabismus after orbital wall fracture and in three patients with high AC/A accommodative esotropia. Using Worth 4-dot tests, we compared the amount of incomitant deviation before and after surgery. RESULTS: The mean decrease in deviation after surgery was 7.8+/-2.6PD(P=0.04) in patients with strabismus after orbital wall fracture, and 11.3+/-4.2PD in those with high AC/A ratio accomodative esotropia. CONCLUSIONS: The posterior fixation suture was effective in reducing the amount of incomitant deviation occurring in cases of strabismus after orbital wall fracture and cases of high AC/A accommodative esotropia.

Long-term Outcomes after Surgery for Congenital Unilateral Cataract

PURPOSE: To evaluate the long-term visual outcome after surgery for congenital unilateral cataract in children. METHODS: We retrospectively analyzed age, associated ocular disease, preoperative and postoperative visual acuity, type of cataract, operation method, and final visual outcome in 34 children, 12 years or younger, that had undergone congenital unilateral cataract surgery with a minimum follow-up period of one year. RESULTS: The mean age was 4.9 years and the mean follow-up duration was 26.5 months. Final visual acuity was less than 0.1 in 41.2%, better than 0.2 in 58.8%, better than 0.5 in 32.4%, and better than 0.8 in 20.6%. In the group whose preoperative visual acuity was less than 0.1, 27.2% of the eyes had a final visual acuity better than 0.5. This outcome is statistically significant compared with the 71.4% in the group whose preoperative visual acuity was better than 0.2 (p=0.02). In comparing the portion of patients whose final visual acuity was better than 0.5, only 8.3% were in the age group younger than 2 years at surgery; this is significantly lower than the 40.0% of patients in the age group between 3 to 6 years and the 50.0% of patients older than 7 years (p=0.03) whose final visual acuity was better than 0.5. CONCLUSIONS: Because long-term outcome of surgery for congenital unilateral cataract is not always satisfactory, it is necessary to determine the proper surgical time according to preoperative visual disturbance or severity of cataract, and to also do optical correction and aggressive treatment for amblyopia postoperatively.