In 1989, Dr. Pratt-Johnson reported on sensory outcomes of 4 patients who had unilateral congenital cataract.  In these cases, surgery was performed from 2.5 to 7 months of age, and at that time, surgical technique was by needling and aspiration or with an ocutome, eyes were fitted with a rigid contact lens, and patching of the fellow eye 80-90% of waking hours was initiated.  In these 4 patients with good compliance to treatment, fusion and stereopsis were lacking, and diplopia was present in all, but intermittent in two. 

Since that time, treatment for unilateral infantile cataract has evolved, including recommendations for surgery by 6 weeks, less aggressive patching (near 50% of waking hours), and consideration of primary or early secondary IOL placement. The Infant Aphakia Treatment Study (IATS) was a prospective trial that compared outcomes in children randomized to contact lens correction of aphakia to primary IOL implantation for unilateral infantile cataract.  The IATS also provided additional information with regard to strabismus, sensory outcomes, as well as parental perceptions and stress regarding patching.  While the results of the IATS probably represent the best possible outcomes due to support for families provided by the study, there are few large studies that explore the sensorimotor outcomes of these patients.

This presentation will review historical and contemporary study results and recommendations for treatment of children with unilateral infantile cataract.  In addition, outcomes will be presented from our patients at Boston children’s Hospital who underwent surgery for unilateral infantile cataract over a 25-year period.  We included all cases with isolated unilateral cataract, excluding those with concurrent retinal disease or significant anterior segment dysgenesis that could impact visual outcome, and those with less than 3 years follow up in order to have measures of recognition acuity and sensorimotor function.  Case examples demonstrating management techniques that can improve outcomes will be presented.