Abstract
<title>Abstract</title> <p>Background Unilateral congenital cataract associated with posterior capsular abnormalities, when treated after infancy, produces variable degrees of visual deprivation. The relationship between the extent of lens opacity and long-term visual outcomes remains unclear. Methods Six patients with unilateral congenital cataract caused by posterior capsular abnormalities who underwent lens extraction and intraocular lens implantation were reviewed. Lens opacity area (LOA) was quantified from intraoperative still images. Postoperative best-corrected visual acuity (BCVA), stereopsis, and retinal structure were evaluated after age 6 using spectral-domain optical coherence tomography. Correlations among LOA, BCVA, stereopsis, and central inner retinal layer thickness were analyzed. Associations were evaluated using Spearman rank correlation. Results Postoperative BCVA ranged from − 0.1 to 1.4 logMAR. Larger LOA was associated with poorer BCVA (ρ = 0.88, p = 0.02). Thinning of the central inner plexiform layer correlated negatively with BCVA (ρ = −0.98, p = 0.002), and ganglion cell layer thickness also correlated negatively with BCVA (ρ = −0.92, p = 0.016). Eyes with smaller LOA values generally achieved better visual outcomes and retained measurable stereopsis, whereas those with larger LOA values showed loss of stereopsis and more pronounced central retinal structural alterations. Conclusions Lens opacity area was associated with visual acuity, stereopsis, and macular inner retinal structure. Quantitative assessment of opacity size may provide additional information regarding deprivation severity and visual prognosis.</p>