Intraocular Lens Implantation during Early Childhood: A Report by the American Academy of Ophthalmology.

PURPOSE: To compare the visual outcomes and adverse events associated with optical correction using an intraocular lens (IOL), contact lenses, or spectacles after cataract surgery in children 2 years of age or younger. METHODS: Literature searches were conducted in PubMed, the Cochrane Library, and the databases of clinical trials in February 2019, without date or language restrictions. The search resulted in 194 potentially relevant citations, and 34 were selected for full-text review. Fourteen studies were determined to be relevant to the assessment criteria and were selected for inclusion in this assessment. The panel methodologist then assigned a level of evidence rating to these studies. RESULTS: Intraocular lenses were associated with visual outcomes similar to outcomes for contact lenses or spectacles for children who had both bilateral and unilateral cataracts. Intraocular lenses were also associated with an increased risk of visual axis opacities. All treatments were associated with a similar incidence of glaucoma. Although ocular growth was similar for all treatments, infants younger than 6 months who underwent IOL implantation had large myopic shifts that often resulted in high myopia or severe anisometropia later in childhood. Corneal endothelial cell counts were lower in eyes that underwent IOL implantation. The incidence of strabismus was similar with all treatments. CONCLUSIONS: Intraocular lens implantation is not recommended for children 6 months of age or younger because there is a higher incidence of visual axis opacities with this treatment compared with aphakia. The best available evidence suggests that IOL implantation can be done safely with acceptable side effects in children older than 6 months of age. However, the unpredictability of ocular growth means that these children will often have large refractive errors later in childhood that may necessitate an IOL exchange or wearing spectacles or contact lenses with a large refractive correction. In addition, the training and experience of the surgeon as well as ocular and systemic comorbidities should be taken into consideration when deciding whether IOL implantation would be appropriate.

Evaluation of eye-related parameters and adverse events of rigid gas permeable contact lens and spectacles correction in infants with monocular aphakia after congenital cataract surgery: a retrospective clinical study.

BACKGROUND: Congenital cataract is currently one of the leading blindness-causing eye diseases in children. Surgical treatment only opens the visual pathway for children. The postoperative recovery of visual function is also dependent on effective optical correction and visual function training. In this study, we analyzed the changes in eye-related parameters, adverse events and the annual cost of rigid gas permeable contact lens (RGPCL) and spectacles correction in infants with monocular aphakia after congenital cataract surgery. METHODS: To analyze the postoperative visual acuity, strabismus, nystagmus, myopic shift, globe axial length growth, adverse events, patient adherence to patching, and annual cost for patients with unilateral congenital cataract who underwent cataract surgery. Rigid gas permeable contact lenses or spectacles were used to correct aphakia after congenital cataract. RESULTS: Of the 49 patients, 20 patients with unilateral aphakia who used RGPCL were in group 1. Group 2 comprised 14 patients with persistent fetal vasculature (PFV) who used RGPCL, and there were 15 patients with spectacles in group 3. In group 1, there were important improvements in visual acuity, strabismus and nystagmus. In groups 2 and 3, there were no significant improvements in visual acuity, strabismus or nystagmus. Patients with a good adherence to patching had better visual acuity after the operation than patients who did not, in groups 1 and 3. There were no significant differences in myopic shift or rate of globe axial length growth among the 3 groups. No patients in group 1 had ocular disease that affected visual acuity. The mean annual expenses of the RGPCL group was 3965 yuan, and the mean annual cost of spectacles was 1140 yuan to 2500 yuan. CONCLUSION: RGPCL is a safe and effective optical correction method for patients with monocular aphakia after congenital cataract surgery. Spectacles are not an ideal optical correction. Using RGPCL to correct patients with PFV, the final visual acuity improved, but the difference was not statistically significant. There were no improvements in strabismus or nystagmus in patients with PFV.

Update on congenital cataract surgery management.

PURPOSE OF REVIEW: The basic procedure of pediatric cataract surgery has not dramatically changed over the past few years. Recent multicenter study results along with technological innovations, however, have increased our understanding and armamentarium of techniques and devices used to improve outcomes. RECENT FINDINGS: We review surgical techniques that have been recently applied to the management of pediatric cataracts and describe newer intraocular lenses that have become available for use in the pediatric population. The 5-year results of the Infant Aphakia Treatment Study, including visual outcomes and complications, as well as other studies comparing intraocular lens implants with contact lenses for infants have shaped our management of congenital cataract. We also discuss how ocular imaging with optical coherence tomography has enhanced our understanding of the microstructural effects on pediatric eyes after cataract surgery and touch on other future innovations. SUMMARY: We review updates in the management of congenital cataract, which remains a major cause of preventable childhood blindness.

Retropupillary fixation of iris-claw lens in visual rehabilitation of aphakic eyes.

CONTEXT: Surgical outcome of retropupillary fixation of iris claw lens. AIMS: To evaluate the various indications, intra and post-operative complications, and visual outcome of retropupillary fixation of iris claw lens in aphakic eyes. SETTINGS AND DESIGN: The study design is a retrospective study at a tertiary eye care center. METHODS: Review of medical records of 61 aphakic eyes of 61 patients, who were rehabilitated with retropupillary fixation of an iris claw lens, with a follow-up duration of at least 1 year. STATISTICAL ANALYSIS USED: Data analysis was performed using paired t-test and Chi-square test. RESULTS: Mean preoperative uncorrected visual acuity was 1.66 ± 0.3 LogMAR and postoperative acuity at 1 year was 0.53 ± 0.5 LogMAR (P = 0.00001). Preoperative distant best-corrected visual acuity was 0.30 ± 0.48 LogMAR and postoperative acuity at 1 year was 0.27 ± 0.46 LogMAR (P = 0.07). Mean preoperative astigmatism was 1.43 ± 1.94 D and postoperatively was 1.85 ± 2.16 D (P = 0.0127). Mean endothelial cell count was 2353.52 ± 614 cells/mm2 preoperatively which decreased to 2200 ± 728 cells/mm2 at 1 year follow-up (P = 0.006). There was no significant difference in central macular thickness and intraocular pressure pre and post-surgery. Complications included ovalization of pupil in 9.83%, hypotony in 1.63%, toxic anterior segment syndrome in 1.63%, cystoid macular edema in 11.47%, epiretinal membrane in 3.27%, and iris atrophy in 6.55%. CONCLUSION: Iris claw is a safe and an effective method of rehabilitating aphakic eyes.

Is an iris claw IOL a good option for correcting surgically induced aphakia in children? A review of the literature and illustrative case study.

Refractive correction of aphakia in childhood can be a complex management issue following lensectomy for congenital cataract or ectopia lentis. Some children have inadequate capsular support to allow an 'in the bag' or sulcus fixated intra-ocular lens (IOL). In such cases, options for refractive correction include spectacles, contact lenses, or surgically fixed IOLs. Many methods of IOL fixation have been described, but none are widely adopted in children. In recent years, the iris-fixated Artisan Aphakic IOL has gained popularity, but there is still significant concern about the rate of corneal endothelial cell loss and IOL de-enclavation. Here, we review the current literature on the use of iris-fixated IOLs in children, the published data on endothelial cell loss and de-enclavation rates. We present a case illustrating the significant improvements in quality of life, which can be seen in selected children, and also the rate of endothelial cell loss, which can be encountered after initial surgery, and a re-enclavation event. We make the case that until more data are available on normal endothelial cell decline in early childhood, in addition to age-specific rates of endothelial cell loss and de-enclavation rates following surgery, the use of iris-fixated IOLs in children will continue to be a moot point and is unlikely to be widely adopted.

State of the Art in Pediatric Cataract Surgery.

Pediatric cataract surgery has evolved dramatically in the past 10 years. Our understanding of the child's eye both in terms of tissue mechanics, neurobiological plasticity and physiological growth has allowed better and better surgical outcomes. The fact remains that the younger the child - infants especially - the more difficult the surgery. It is also true to say that not only is a child's eye not a small adult eye, but also that the child him- or herself is not a small adult. The importance of this statement is evident when we discuss the effects of anesthesia and fluid input in infants during infant cataract surgery. This chapter discusses the factors that should help give a child the best possible outcome after cataract surgery including timing of surgery, type of operation, biometry, the size and type of intraocular lens material , postoperative refraction, operative considerations, wound size and type, capsule management, anterior vitrectomy technique, wound closure and viscoelastic removal and perioperative medications.

Visual Rehabilitation in Pediatric Aphakia.

The management of childhood cataract begins at the initial contact with the family and typically extends far into the child's future. Decisions affecting long-term care and visual outcomes are often made in these initial preoperative encounters. Treatment will vary depending on whether the cataract is unilateral or bilateral and whether it is infantile onset or later. Thorough discussion of the treatment options is needed, especially with description of the life-long management issues for the child. Visual outcomes will vary, with the best visual acuity results being observed in older children with bilateral cataracts. Visual rehabilitation of children with unilateral cataract requires use of a contact lens or an intraocular lens (IOL) for the best result with a chance for binocularity. Only about 50% of eyes with unilateral infantile cataract will develop vision of better than 20/200. For bilateral cataracts, both contacts and IOLs can be used, as well as aphakic glasses. Excellent visual outcomes are typical unless glaucoma develops, which occurs in up to 30% of cases. Cataract surgery after 1 year of age is associated with substantially better visual outcomes. The use of an IOL is most commonly accepted and performed for cataract in one or both eyes after 1 year of age. Prior to 1 year of age, significantly more secondary surgical procedures are required to manage opacification of the optical axis with the use of an IOL compared with the use of surgery and contact lens correction. Amblyopia therapy for unilateral cataract needs be continuous from the time of surgery until at least 8 years of age. It is often difficult to perform this therapy over such a long time period, with compliance with less than 30% of prescribed time during infancy at 5 years after surgery.

Intraocular lenses and clinical treatment in paediatric cataract

Pediatric cataract is the most common treatable cause of blindness in children. Prevalence, etiology and morphology vary with the socioeconomic development. The treatment goal is to reduce amblyopia, being difficult management especially in unilateral cases. The decision on aphakia or primary intraocular lens should be individualized as well as correction with contact lens or spectacles. The intraocular lens single-piece hydrophobic acrylic are the most implanted in children and the preferably is in the capsular bag. The Sanders-Retzlaff-Kraff theoretic (SRK/T) stressing that is described as more predictable, following Holladay I and SRK II and the recommendation is to under correction +6.0 or +8.0 dioptrias expecting the growth of the eye. The posterior capsule opacity is the most frequent complication and varies with the material choice of the lens. Glaucoma is the most serious postoperative complication and depends on the timing of the surgery, primary lens implantation and time of post surgical follow-up. The adherence to occlusion therapy with patching is critical to the visual prognosis and is determined by the child’s age and laterality of the cataract. There was significant improvement in the surgery and in IOLs, however the final visual prognosis is still not desirable.

A catarata pediátrica é a causa mais comum de cegueira tratável em crianças. Prevalência, etiologia e morfologia variam conforme o desenvolvimento sócioeconômico. O tratamento tem como objetivo diminuir a ambliopia, sendo de difícil manejo principalmente em casos unilaterais. A decisão sobre afacia ou implante primário de lente intraocular deve ser individualizado, assim como a correção com lente de contato ou óculos. As lentes intraoculares acrílicas hidrofóbicas de peça única são as mais implantadas em crianças com preferência de implante no saco capsular. A fórmula biométrica Sanders-Retzlaff-Krafftheoretic (SRK/T) é a mais precisa em pacientes pediátricos, seguida de Holladay I e SRK II, com recomendação de sob correção de +6 a +8.0 dioptrias, devido ao esperado crescimento rápido do globo ocular. A opacidade de cápsula posterior é a complicação mais frequente e varia com o material da lente a ser implantada e o glaucoma é a complicação pós-operatória mais grave e depende da idade da criança na cirurgia, implante primário de LIOs e da duração do acompanhamento pós-cirúrgico. A adesão ao tratamento oclusivo é fundamental para o prognóstico visual, sendo determinado de acordo com a idade da criança e a lateralidade da catarata. Mesmo com a melhora do tratamento cirúrgico e das lentes intraoculares o prognóstico visual final ainda não é o desejável.

Using continuous intraoperative optical coherence tomography measurements of the aphakic eye for intraocular lens power calculation.

BACKGROUND/AIMS: To include intraoperative measurements of the anterior lens capsule of the aphakic eye into the intraocular lens power calculation (IPC) process and to compare the refractive outcome with conventional IPC formulae. METHODS: In this prospective study, a prototype operating microscope with an integrated continuous optical coherence tomography (OCT) device (Visante attached to OPMI VISU 200, Carl Zeiss Meditec AG, Germany) was used to measure the anterior lens capsule position after implanting a capsular tension ring (CTR). Optical biometry (intraocular lens (IOL) Master 500) and ACMaster measurements (Carl Zeiss Meditec AG, Germany) were performed before surgery. Autorefraction and subjective refraction were performed 3 months after surgery. Conventional IPC formulae were compared with a new intraoperatively measured anterior chamber depth (ACD) (ACDIntraOP) partial least squares regression (PLSR) model for prediction of the postoperative refractive outcome. RESULTS: In total, 70 eyes of 70 patients were included. Mean axial eye length (AL) was 23.3 mm (range: 20.6-29.5 mm). Predictive power of the intraoperative measurements was found to be slightly better compared to conventional IOL power calculations. Refractive error dependency on AL for Holladay I, HofferQ, SRK/T, Haigis and ACDintraOP PLSR was r(2)=-0.42 (p<0.0001), r(2)=-0.5 (p<0.0001), r(2)=-0.34 (p=0.010), r(2)=-0.28 (p=0.049) and r(2)<0.001 (p=0.866), respectively, CONCLUSIONS: ACDIntraOP measurements help to better predict the refractive outcome and could be useful, if implemented in fourth-generation IPC formulae.

Combined pars plana and limbal approach for removal of congenital cataracts.

UNLABELLED: We describe a combined pars plana-limbal approach using a 25-gauge transconjunctival sutureless vitrectomy system for removal of congenital cataracts in a 5-month-old boy. The operated eye had anterior capsulotomy, lensectomy, posterior capsulotomy, and anterior vitrectomy through a pars plana transconjunctival incision created with a 25-gauge trocar. A limbal port incision was used to introduce an infusion micro cannula to maintain the anterior chamber. Incisions did not require suture closure. Following the procedure, inflammation was mild, the pupil was circular and centric, and the intraocular pressure (IOP) was stable. The eyes were left aphakic, and vision was corrected with spectacles. Amblyopia treatment ensued. This surgical technique appears to be safe and effective for the removal of congenital cataracts. Advantages include a more precise capsulotomy and more sufficient lensectomy and anterior vitrectomy, stable intraoperative IOP, and reduced surgical trauma and inflammation. FINANCIAL DISCLOSURE: No author has a financial or proprietary interest in any material or method mentioned.

Axial elongation following cataract surgery during the first year of life in the infant Aphakia Treatment Study.

PURPOSE: To compare ocular axial elongation in infants after unilateral cataract surgery corrected with a contact lens (CL) or primary intraocular lens (IOL) implantation. METHODS: Baseline axial length (AL) was measured at the time of cataract surgery (1-6 months) and at age 1 year. AL at baseline and age 1 year and the change in length/mo were analyzed in relation to treatment modality, cataractous versus fellow eye, and age at surgery using linear mixed models. RESULTS: Mean baseline AL did not differ between the CL and IOL groups for either cataractous or fellow eyes. Eyes with cataracts were shorter than fellow eyes by an average of 0.6 mm (95% confidence interval [CI], 0.4-0.8 mm; P < 0.0001). For the operated eyes, the mean change in AL/mo was smaller in the CL group (0.17 mm/mo) than in the IOL group (0.24 mm/mo) (P = 0.0006) and was independent of age at surgery (P = 0.19). In contrast, the change in AL/mo for fellow eyes decreased with older age at surgery (P < 0.0001). At age 1 year, operated eyes treated with a CL were 0.6 mm shorter on average than operated eyes treated with an IOL (P = 0.009). CONCLUSIONS: At baseline, eyes with cataracts were shorter than fellow eyes. The change in AL/mo was smaller in operated eyes treated with a CL than in operated eyes treated with an IOL, but was not significantly related to age at surgery. (ClinicalTrials.gov number, NCT00212134.).

Simultaneous Descemet stripping automated endothelial keratoplasty and aphakic iris-fixated intraocular lens implantation: a case series.

PURPOSE: To report 3 cases of simultaneous Descemet stripping automated endothelial keratoplasty (DSAEK) and aphakic iris-fixated intraocular lens (IOL) implantation in patients with aphakia and bullous keratopathy. METHODS: We retrospectively documented the clinical characteristics of patients before and after simultaneous DSAEK and aphakic iris-fixated IOL implantation undergoing operation between November 2008 and September 2009. RESULTS: None of the cases showed any intraoperative complications. During the postoperative period, the corneal lenticule was clear and well-attached, and the iris-fixated IOL was well-positioned. CONCLUSIONS: Simultaneous DSAEK and aphakic iris-fixated IOL implantation can be used successfully and simultaneously in patients with aphakia and bullous keratopathy.

Dealing with retinal detachment in a patient with aphakia, an Artisan lens, and an ExPress valve in situ.

PURPOSE: To report our experience from a case with a retinal detachment in an eye with aphakia, an Artisan phakic anterior chamber lens, and an ExPress valve and describe its course after vitrectomy and gas tamponade. METHODS: Interventional case report. RESULTS: A 65-year-old man who had previously undergone cataract extraction, Artisan/Verisyse lens implantation, and ExPress valve insertion for the treatment of aphakia and refractory glaucoma presented with a superior retinal detachment. The patient underwent a 20-g pars plana 20g vitrectomy, cryotherapy, and sulfur hexafluoride (SF(6)) tamponade. Twenty days after vitrectomy, the Artisan lens remained in place and the retina attached. Twelve months postoperatively, the situation remained unchanged. CONCLUSION: Iris-claw lenses have been introduced in 2004 as an alternative option for the correction of aphakia. Vitreoretinal surgeons face a new therapeutic challenge since data with regard to retinal detachment repair in patients with Artisan lenses are very limited. In our case, all intraoperative vitrectomy manipulations were performed without difficulty through the Artisan lens, which remained stable during fluid-air exchange as well as postoperatively, despite the movements of the gas bubble and the presence of the ExPress valve. Moreover, there was no displacement of the ExPress valve during the intraoperative manipulations of vitrectomy or dysfunction of the valve due to the existence of the gas in the postoperative period.

Long-term results of early contact lens use in pediatric unilateral aphakia.

OBJECTIVES: To evaluate which factor(s) might predict excellent Snellen visual acuity results in unilateral nontraumatic pediatric aphakes. METHODS: Retrospective review of all unilateral pediatric aphakic patients seen in a specialty contact lens clinic between 1982 and 2009. Inclusion criteria as follows: (1) cataract extraction before age 6 weeks, (2) no other health complications, (3) contact lens fitting within 3 weeks postsurgery, and (4) measurable subjective visual performance on a clinical Snellen acuity chart. Fifteen patients were identified: 10 patients with persistent fetal vasculature syndrome (PFV) and 5 patients with the diagnosis of idiopathic congenital cataract (ICC). RESULTS: Final Snellen acuity results showed seven patients (46.67%) developed excellent Snellen visual acuities (defined as 20/50 or better), four patients (26.67%) developed moderate Snellen visual acuities (20/125 to 20/60), and four total patients (26.67%) developed poor Snellen visual acuities (worse than 20/200). Analysis used descriptive statistics. CONCLUSIONS: Approximately 50% of our unilateral nontraumatic pediatric aphakic patients aged older than 5 years achieved excellent Snellen visual acuity in the aphakic eye. The amount of surgical or ocular complications seems to have an inverse relationship with Snellen visual acuity in PFV. Patching compliance, without implying cause-effect direction, also had a direct relationship with final Snellen visual acuity for patients. Early cataract extraction, good to moderate patching compliance, and aggressive early contact lens management can lead to moderate to excellent Snellen visual results in several unilateral pediatric aphakic patients.

Objective assessment of the quality of vision before and after repositioning of a dislocated iris-fixated aphakic anterior chamber lens.

PURPOSE: To document severe visual symptoms due to the dislocation of an iris-fixated aphakic anterior chamber lens using wavefront aberrometry. METHODS: A patient complaining of severe visual blur and distortion due to a decentered Artisan iris-fixated anterior chamber lens was evaluated pre- and postoperatively after recentration. The patient underwent complete ophthalmic evaluation including the measurement of corneal topography and wavefront aberrations using the NIDEK OPD-Scan. OPD Station software was used to correlate and simulate the patient's symptoms. RESULTS: After the repositioning procedure, the visual symptoms resolved, and high magnitudes of tilt (7.536 microm) and high order aberrations (5.129 microm) were dramatically reduced by simple lens repositioning (4.40-mm pupil). The cylinder magnitude was reduced from 6.25 to 0.75 diopters. CONCLUSIONS: These are the first diagnostic images of this kind in a highly aberrated eye with iris-fixated anterior chamber lens dislocation. The images documented the optical effect and visual consequences of IOL decentration and subsequent recentration.

Long-term reversibility of epikeratophakia.

PURPOSE: To assess the long-term reversibility of epikeratophakia. METHODS: Three human epikeratophakia lenticules (from 3 patients) were removed 7-14 years after refractive keratoplasty for aphakia (n = 1) and myopia (n = 2). Reasons for removal were irregular astigmatism (n = 1), opacities in the graft and host cornea, and progressive myopia (n = 2). After removal, 2 patients underwent cataract extraction and 1 underwent secondary implantation of AC-IOL. Visual acuity, refraction, keratometry, and corneal topography were assessed before and after removal of the lenticule, as well as after the cataract and IOL implantation, and were compared with the initial visual acuity and corneal curvature before epikeratoplasty. RESULTS: After removal of the lenticule, the 3 patients regained the initial curvature of the cornea (pre-epikeratoplasty), and remained stable during 6 months of follow-up. Initial best-corrected visual acuity and refraction before epikeratoplasty were restored after removal of the epikeratoplasty lenticule in the aphakic patient. Original best-corrected visual acuity was restored in the 2 myopic cataract patients after cataract extraction and IOL implantation. CONCLUSIONS: In a small care series, epikeratophakia was found to be a reversible procedure even after 7-14 years.

Changes in water content of high plus hydrogel lenses worn on an extended wear basis in a geriatric aphakic population.

PURPOSE: To investigate the water content of hydrogel lenses of relatively high plus power hydrogel lenses after 3 months extended wear and compare values with unused lenses. METHOD: Geriatric aphakic extended wear soft lens patients were fitted with one of four different brands of hydrogel lenses (A) Incanto 78 (Cantor and Nissel, UK), (B) PSL72 (Prospect lenses, UK), (C) ES70 (Ocular Sciences), (D) Proclear (Coopervision). After 3 months continuous wear the lens was removed and water content (WC) was determined at both lens surfaces using an Abbé refractometer. The water content was also measured for 40 unused lenses (+10 to +20D, 10 lenses per brand). RESULTS: One hundred and thirty-two lenses were checked after 3 months extended wear. Mean (+/-S.D.) WC values for front (f) and back (b) surfaces of worn and unworn lenses were, respectively, (A) Worn (n=45): f 73.2(4.13) b 73.8(4.33); unworn f 80.5(0.68) b 81.1 (0.80). (B) Worn (n=37); f 70.5(4.49) b 70.9 (3.89); unworn f 72.5(0.94) b 72.3 (0.89). (C) Worn (n=34); f 68.3(3.18) b 68.4(3.63); unworn f 70.6 (0.48) b 71.1 (0.55). (D) Worn (n=16); f 63.4(3.68) b 63.3(3.19); unworn f 60.9 (1.56) b 61.5 (1.92). There was a significant correlation between WC measured from front and back surfaces (p < 0.01). In worn A-C lenses, front surface WC tended to be lower than back surface WC. For lenses A and C at both surfaces the WC of worn lenses was significantly lower than unworn lenses (p < 0.05). For lens D, mean WC of worn lenses was significantly higher than unworn lenses (p < 0.05). In 80% of B lenses, surface WC of worn lenses were significantly lower than WC of unworn lenses (p < 0.05). There was no relationship between WC and lens power. CONCLUSION: On average, A and C lenses tended to desiccate but D lenses tended to swell as did 20% of B lenses. The front surface of worn lenses measured lower water content than the back surface suggesting the front surface is drier than the back. This apparent difference in water content between the surfaces could be an artefact emanating from differential rates of surface deposition.

Results of surgery for bilateral cataract associated with sensory nystagmus in children.

PURPOSE: To report the outcome of cataract surgery in children with bilateral cataract and preoperative sensory nystagmus. DESIGN: Interventional case series. METHODS: Retrospective review of 95 children who underwent surgery for bilateral cataract associated with sensory nystagmus. All patients lacked other structural ocular defects or neurologic abnormalities and were old enough at last follow-up to cooperate with recognition visual acuity testing. Outcome parameters studied were best-corrected postoperative visual acuity of the better eye and postoperative reduction or elimination of nystagmus. RESULTS: Mean age at surgery +/- SD was 2.0 +/- 2.6 years (range, 1 month to 13 years). Mean follow-up was 6.1 +/- 3.4 years (range, 2 months to 15 years). Best-corrected postoperative visual acuity of the better eye ranged from 20/25 to counting fingers and was 20/60 or better in 44 (46%), between 20/60 and 20/200 in 37 (39%), and 20/200 or worse in 14 (15%). Preoperative recognition visual acuity data were available for 16 of the older patients, and 5 or more lines of visual acuity improvement occurred in 5 (31%) including children as old as 9 years at the time of surgery. Nystagmus was reduced or eliminated postoperatively in 38 (40%). Mild, as opposed to severe, preoperative nystagmus was predictive of both a better visual acuity outcome (P =.004) and reduced or eliminated nystagmus postoperatively (P =.02). CONCLUSIONS: Good or even excellent visual acuity can be achieved after cataract surgery in some children with bilateral cataract and sensory nystagmus, and the nystagmus sometimes improves postoperatively.