Systemic steroid-induced cataracts in children: long-term changes in morphology and visual acuity

Purpose: To report the long-term visual prognosis and surgical rates of steroid-induced cataracts in children.

Methods: The medical records of children diagnosed with steroid-induced cataracts who were followed up for more than 5 years were retrospectively reviewed. Children over 3 years of age who cooperated with the initial visual acuity test (Snellen chart) were included. The following data were evaluated: best-corrected visual acuity at the time of diagnosis and at final follow-up, morphologic changes in the cataract, and surgical outcomes and associated systemic diseases that required steroid treatment.

Results: A total of 59 eyes of 30 patients with posterior subcapsular cataracts were included. The mean follow-up period after diagnosis was 7.6 ± 2.9 years (range, 5-14.5 years). Cataracts were graded on the basis of the size of lens opacity. Cataract progression was defined as widening of the lens opacity. Cataracts progressed in 20 eyes (34%) and remained unchanged in 39 eyes (66%). Three patients underwent bilateral cataract surgery because of cataract progression and significant loss of visual acuity. Of the 53 eyes of 27 children (90%) who did not undergo surgery, best-corrected visual acuity did not change significantly during the follow-up period.

Conclusions: In this study cohort, cataract progressed in 34% of the eyes with steroid-induced cataract; however, surgery was required in only 10% of the children, and in these patients the postoperative visual outcome was favorable.