Relationship between the timing of cataract surgery and development of nystagmus in patients with bilateral infantile cataracts

Purpose: To study the relationship between timing of surgery as a risk factor for the development of manifest nystagmus in patients with bilateral infantile cataracts and to determine the effect of nystagmus on visual outcomes.

Methods: The medical records of patients with bilateral infantile cataracts operated on before 12 months of age between January 1991 and December 2009 were retrospectively reviewed. Patients were stratified into two groups: early (age <8 weeks) or late (age >8 weeks) surgery.

Results: A total of 56 patients (29 males) were studied. Early surgery was performed in 26 patients. Of these, 10 (38%) had manifest nystagmus at the most recent follow-up. Of 30 patients who underwent late surgery, 15 (50%) had manifest nystagmus at the most recent follow-up. There was not a statistically significant impact on the timing of cataract surgery and the development of postoperative nystagmus (P = 0.43). In total, 25 of 56 (45%) patients had postoperative manifest nystagmus; in these patients, there was a statistically significant decrement in final logMAR visual outcomes compared with those patients without postoperative nystagmus (0.26 vs 0.16; P = 0.04); however, preoperative nystagmus did not appear to be a risk factor for a worse visual outcome.

Conclusions: Manifest nystagmus is a common feature in children with bilateral infantile cataracts, regardless of the timing of surgery. Early surgery as defined in this study does not necessarily prevent its development. Postoperative nystagmus is more common when surgery is performed later but can improve as the child matures.