Contact Lenses for Visual Habilitation in Infantile Aphakia: Long-Term Visual Outcomes and Factors Affecting Treatment Success.

Purpose: To present the long-term visual outcomes and factors affecting treatment success in children with congenital cataract surgery in infancy followed by optical correction by contact lens (CL).

Methods: We retrospectively analyzed data from 30 eyes of 26 pediatric aphakic patients followed by visual habilitation primarily by CL between 2004 and 2023. The patients were evaluated for factors affecting final best-corrected visual acuity (VA), need for additional surgery, and adherence to CL and occlusion therapy.

Results: The study included 16 eyes with idiopathic congenital cataract, 12 eyes with congenital cataract associated with persistent fetal vasculature, and two eyes with concomitant retinopathy of prematurity. Adherence to CL use was evaluated as poor in 13.3%, moderate in 40%, and good in 46.7% of the eyes, while adherence to occlusion therapy was poor in 33.3%, moderate in 20.8%, and good in 45.8% of the eyes. Final VA was 20/50 or better in 50% of the eyes, between 20/50 and 20/400 in 16.7% of the eyes, and 20/400 or worse in 33.3% of the eyes. There was no statistically significant relationship between the presence of strabismus and final VA, whereas the need for additional surgery; the presence of posterior segment pathologies, nystagmus, and glaucoma; and poor treatment adherence were associated with significantly lower final VA.

Conclusions: Good long-term visual outcomes can be achieved with effective CL and occlusion therapy in cases of infantile aphakia not accompanied by glaucoma, severe anterior and posterior segment pathologies, or the need for additional surgery.