Efficacy and safety of early surgical interventions in children with bilateral congenital cataracts: a systematic review of visual outcomes, neurodevelopment, and long-term complications

Background: Bilateral congenital cataracts (BCC) cause preventable childhood blindness with a global prevalence of 0.63–13.6 per 10,000 children. Early visual deprivation disrupts neurodevelopment and make surgical timing critical. Despite early intervention (<6–12 weeks) being standard, its long-term efficacy and safety remain debated for risks like glaucoma and visual axis opacification (VAO). Objective: Evaulate impact of early surgery (<6 weeks, <10 weeks, <3 months) on visual acuity, neurodevelopment and complicatins in children with BCC. Methods: We followed PRISMA guideline during analyzing 15 studies (4 RCTs, 7 cohorts, 3 case series, 1 meta-analysis) from PubMed, EMBASE and Cochrane up to March 2025. Inclusion criteria: children ≤18 years with BCC undergoing surgery within the first year. Outcomes included best-corrected visual acuity (BCVA, logMAR), neurodevelopmental scores (e.g., Bayley Scales) and complications (glaucoma, VAO). Random-effects meta-analysis and narrative synthesis were employed. Results: Early surgery (<12 weeks) improved BCVA (mean logMAR 0.5–0.8 vs. 0.96 in delayed groups) and reduced amblyopia (53% vs. 79%, P < 0.001), but increased glaucoma (26% vs. 6%) and VAO (31% vs. 13%). Pseudophakia and aphakia showed comparable BCVA (0.50 vs. 0.59 logMAR, P = 0.79), though pseudophakic eyes had higher synechiae (27.6% vs. 8%, P = 0.004). Neurodevelopmental benefits were noted with early intervention. Conclusion: Early surgery optimizes visual and neurodevelopmental outcomes. It can raise complication risks. Individualized timing (6–12 weeks) and vigilant postoperative monitoring are recommended.