Efficacy and safety of early surgical interventions in children with bilateral congenital cataracts: a systematic review of visual outcomes, neurodevelopment, and long-term complications
DOI:
https://doi.org/10.56183/iberojhr.v5i2.785Palavras-chave:
Congenital cataracts, Early surgery, Neurodevelopment, Childhood blindness, Aphakia, Pseudophakia.Resumo
Background: Bilateral congenital cataracts (BCC) cause preventable childhood blindness with a global prevalence of 0.63–13.6 per 10,000 children. Early visual deprivation disrupts neurodevelopment and make surgical timing critical. Despite early intervention (<6–12 weeks) being standard, its long-term efficacy and safety remain debated for risks like glaucoma and visual axis opacification (VAO). Objective: Evaulate impact of early surgery (<6 weeks, <10 weeks, <3 months) on visual acuity, neurodevelopment and complicatins in children with BCC. Methods: We followed PRISMA guideline during analyzing 15 studies (4 RCTs, 7 cohorts, 3 case series, 1 meta-analysis) from PubMed, EMBASE and Cochrane up to March 2025. Inclusion criteria: children ≤18 years with BCC undergoing surgery within the first year. Outcomes included best-corrected visual acuity (BCVA, logMAR), neurodevelopmental scores (e.g., Bayley Scales) and complications (glaucoma, VAO). Random-effects meta-analysis and narrative synthesis were employed. Results: Early surgery (<12 weeks) improved BCVA (mean logMAR 0.5–0.8 vs. 0.96 in delayed groups) and reduced amblyopia (53% vs. 79%, P < 0.001), but increased glaucoma (26% vs. 6%) and VAO (31% vs. 13%). Pseudophakia and aphakia showed comparable BCVA (0.50 vs. 0.59 logMAR, P = 0.79), though pseudophakic eyes had higher synechiae (27.6% vs. 8%, P = 0.004). Neurodevelopmental benefits were noted with early intervention. Conclusion: Early surgery optimizes visual and neurodevelopmental outcomes. It can raise complication risks. Individualized timing (6–12 weeks) and vigilant postoperative monitoring are recommended.
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Copyright (c) 2025 Males Caiza Cinthya Jhoana, Juan Felipe Buitrago Navarro, Sara Esther Herazo Herazo, Luis Miguel Martinez Garzon, Franklin Marcelo Noboa Ibarra, Lina Paola Olivero Díaz, Lucia Margarita Franco Osorio
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