(1) Background: Congenital cataract is a rare but severe childhood ocular disorder that can lead to permanent visual impairment if left untreated. Factors influencing long-term visual outcomes are insufficiently defined. The aim of this study was to evaluate long-term visual outcomes after congenital cataract surgery and to identify factors associated with visual acuity impairment and reoperation rates. (2) Methods: This retrospective cohort study included 173 eyes of 116 patients who underwent surgery for congenital cataract at the University Hospital Essen between 2000 and 2018. Patients with a minimum postoperative follow-up of six years were included. Best-corrected visual acuity (BCVA) was analyzed according to binocular condition, age at surgery and the presence of comorbidities. Postoperative complications and the need for additional surgical interventions were evaluated. (3) Results: Unilateral cataract was present in 48% (n = 56) and bilateral cataract in 52% (n = 60) of patients. Age at surgery ranged from 2.1 weeks to 15.6 years in unilateral cases and from 3.1 weeks to 8.7 years in bilateral cases. Six years after surgery, mean BCVA was 1.0 logMAR (Snellen 20/200) in unilateral cases and 0.4 logMAR (Snellen 20/50) in bilateral cases. No significant association was found between long-term BCVA and either age at surgery or ocular or systemic comorbidities. Patients with microphthalmia and those born prematurely showed significantly higher rates of additional surgical procedures. (4) Conclusions: Bilateral cases of congenital cataract achieved a significantly better visual acuity than unilateral cases after surgery. In this cohort, neither age at surgery nor the presence of comorbidities was significantly associated with visual acuity, whereas microphthalmia and prematurity were linked to an increased likelihood of additional surgical interventions.

Purpose: We report a rare case of bilateral Brown's syndrome associated with Parry-Romberg Syndrome (PRS), highlighting this rare syndromic association and its possible shared pathophysiology. Methods: An 8-year-old female presented with longstanding right-eye inward deviation and decreased vision in the right eye. Ocular examination revealed bilateral limitation of elevation in adduction, consistent with Brown's syndrome. Systemic findings included progressive right-sided facial atrophy, preauricular skin anomalies, and dental abnormalities. Imaging and laboratory investigations confirmed PRS. Surgical management and ongoing follow-up outcomes were documented. Results: Forced duction testing demonstrated bilateral superior oblique tightness. Imaging revealed generalized extraocular muscle atrophy with relative fibrosis of the superior obliques. The patient underwent right eye superior oblique tenotomy and 5 mm medial rectus recession under general anesthesia. Postoperatively, ocular alignment improved significantly, with residual 5 prism diopters of hypotropia in primary gaze. Multidisciplinary evaluation confirmed PRS, and amblyopia therapy was initiated with ongoing follow up for progressive facial changes. Conclusion: This is a rare reported case of bilateral Brown's syndrome associated with PRS. This case broadens the ophthalmic spectrum of PRS and suggests a potential link between progressive hemifacial atrophy and restrictive strabismus patterns. Comprehensive ophthalmic and systemic evaluation is essential in such complex presentations.

PurposeTo compare the success rates of botulinum toxin (BTX) injection and conventional strabismus surgery in treating residual esotropia. MethodsThis retrospective cohort study included patients with residual esotropia of >15[Δ] following strabismus surgery treated at a single instituion from 2015 to 2023. Patients were categorized into two groups based on intervention type: the surgery group and the BTX group. The success rate was defined as an angle of deviation of <10[Δ] of esotropia during the last follow-up, at least 3 months after the last intervention. ResultsA total of 41 patients were included: 20 in the surgery group and 21 in the BTX group. No statistically significant differences were observed between the groups in terms of age, sex, spherical equivalent, amblyopia, diagnosis, or preintervention angle of deviation. Mean preintervention angles of deviation were 25.40[Δ] ± 9.36[Δ] in the surgical group and 25.14[Δ] ± 6.76[Δ] in the BTX group, which decreased to 10.45[Δ] ± 9.36[Δ] and 11.52[Δ] ± 13.11[Δ], respectively, after treatment, with no statistically significant difference (P = 0.555). The success rates were 47.6% in the BTX group and 60% in the surgery group (P = 0.427). Exotropia developed in a single patient in each group. Dissociated vertical deviation developed in 2 patients from the surgical group and 1 patient from the BTX group. In the surgical group, 2 patients developed hypertropia; in the BTX group, 4 patients. ConclusionsBTX is comparable to conventional surgery and can be considered in the management of residual esotropia.