An infant undergoes lens aspiration for a dense cataract caused by congenital rubella syndrome. Which statement about the surgical implications is correct?

• A The cataract must be removed within the first week of life to prevent amblyopia
• B Live rubella virus can persist in lens matter for up to 3 years, so surgery may release infectious virus ✓
• C Primary intraocular lens implantation is the standard practice in these infants
• D Rubella cataracts are always anterior polar and never require lensectomy

Explanation

In congenital rubella the virus continues to multiply inside the lens, and viable virus has been recovered from lens matter for as long as 3 years after birth. Surgeons must therefore handle the specimen as infectious. Rubella cataracts are typically pearly white nuclear cataracts, and amblyopia prevention dictates early but not first-week surgery, while IOL implantation in infancy remains controversial.

Reference: Parsons' Diseases of the Eye, 23rd ed.

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