Objective: To evaluate and compare long-term visual outcome and complications between premature and mature infants after bilateral cataract surgery during infancy. Methods: This prospective cohert study included children with bilateral congenital cataracts who were recruited between January 2002 and
July 2012 at Peking University People's Hospital. All patients received simultaneous bilateral cataract extraction combined with primary capsulotomy and anterior vitrectomy. After the operation, all patientswore aphakic glasses during the follow-up periods. The children were divided into premature (gestational
age equal or less than 36 weeks) and mature (more than 36 weeks) groups based on their gestational age. The unilateral and bilateral best corrected visual acuity (BCVA), unilateral and bilateral BCVA distribution, and postoperative complications at the last visit were evaluated and compared. The data were
analyzed with student's t test and chi-square test. Results: Thirty-six premature and 15 mature infants with bilateral congenital cataracts were recruited. The age at surgery, gender composition, longest follow-up period, and the rate of secondary intraocular lens implantation at the last visit were similar between the mature and premature groups. At last visit, the unilateral BCVA (LogMAR) of mature and premature groups was 0.66±0.28 and 0.52±0.27 respectively (t=-2.316, P=0.023), while the bilateral BCVA was 0.54±0.25 and 0.42±0.24 (P>0.05), respectively. The unilateral BCVA (Snellen) was ≥30/50 in 14 eyes
(14/72) of the premature group, while the BCVAs of all children in the mature group were <30/50. The distribution of unilateral BCVA was significantly different between the two groups (χ2=11.229, P=0.022).However, the bilateral BCVA distribution was similar for the two groups (χ2=7.174, P=0.140). The long-term
postoperative complications of the mature and premature children included strabismus (3/15 vs. 8/36),nystagmus (4/15 vs. 14/36), optical opacity (3/15 vs. 3/36), and ocular hypertension (1/15 vs. 1/36). The incidence of each condition was similar between the groups. Conclusions: For most children with bilateral
congenital cataracts, intervention and treatment in the earlier stages of life can still influence long-term visual outcomes. If the condition permits, surgery should be performed as early as possible.