Congenital Cataracts with Thin Lenses (Leptophakia) in Children: Morphology and Surgical Outcomes

Purpose To describe the morphology and postoperative outcomes of pediatric cataracts with thin (leptophakic) lenses. Design Retrospective comparative clinical cohort study. Methods We identified the records of pediatric patients who had undergone cataract surgery between 2018-2023 and lens thickness less than two standard deviations of age-stratified normal eyes in the general population. Matching controls were identified based on sex, age at surgery, and intraocular lens implant status. Data abstracted include axial length, anterior chamber depth, lens thickness, visual acuity, intraocular pressure, and surgical details. Results A total of 13 eyes from seven patients were identified to be leptophakic, 8 of which had matching controls. Compared to the control eyes, leptophakic eyes had thinner lenses (2.74 ± 0.39 mm vs 4.82 ± 1.01 mm, p < 0.01) with comparable anterior chamber depth (3.28 ± 0.76 mm vs 2.98 ± 1.28 mm, p = 0.13) and axial lengths (19.17 ± 2.61 mm vs 20.76 ± 1.76 mm, p = 0.20). Following cataract surgery, visual acuity improved for both the leptophakic and control cohorts within 2.5 months postoperatively (-0.68 ± 0.37 LogMAR vs -0.06 ± 0.42 LogMAR, p = 0.03) and at 1-2 years postoperatively (-1.58 ± 1.03 LogMAR vs -0.60 ± 0.49 LogMAR, p = 0.22) without any glaucoma-related adverse events. Of note, 5 of 13 leptophakic eyes (38%) were found to have posterior capsular ruptures intraoperatively. Conclusions Leptophakic eyes demonstrated similar intraoperative and short-term postoperative outcomes when compared to control eyes, though vigilance for posterior capsular defects and ruptures may be necessary.