Strabismus Accompanying Pediatric Cataracts and the Effect of Cataract Surgery on Strabismus.

Abstract

Objectives: To examine the characteristics of preoperative strabismus, the impact of surgical treatment on existing strabismus, and the features of strabismus developing postoperatively in pediatric cataract patients.

Materials and methods: The records of patients who underwent surgery for pediatric cataract and had at least 1 year of follow-up were reviewed. Preoperative strabismus types, changes in strabismus after surgery, and the characteristics of postoperative new-onset strabismus were examined.

Results: Seventy-seven pediatric cataract surgery patients were evaluated, 58 (75.3%) with congenital cataract and 19 (24.7%) with acquired cataract. The mean follow-up duration was 63 months (range: 13-185 months). Cataracts were bilateral in 39 patients and unilateral in 38 patients. Strabismus was present preoperatively in 21% of unilateral cases and 20.5% of bilateral cases. In unilateral cases, 50% had esotropia (ET) and 50% had exotropia, while in bilateral cases, these rates were 75% and 25%, respectively. Orthotropia was achieved postoperatively for at least for 1 year of follow-up in 25% of patients with preoperative deviation, all of whom had ET. Twenty-nine (47.5%) of 61 patients who had no deviation preoperatively developed strabismus postoperatively. The rate of new-onset postoperative strabismus in patients with unilateral cataract was 91.6% for those operated before 1 year of age and 38.5% in those operated after the age of 1 year (p=0.001). For bilateral cases, these rates were 50% and 22.2%, respectively (p=0.155).

Conclusion: Strabismus development is commonly observed in pediatric cataracts. While preoperative strabismus may resolve after surgery, postoperative rates remain high, especially in unilateral cases operated before 1 year of age. When managing pediatric cataracts, it is important to carefully evaluate not only for deprivation amblyopia but also strabismic amblyopia. Long-term systematic follow-up after cataract surgery is essential for optimal visual outcomes.