For a dense congenital cataract with amblyopia risk, the recommended initial management is:

• A. Early surgical removal with optical correction and amblyopia therapy
• B. Observation
• C. Patch therapy only
• D. Delayed surgery

Answer: (A)

Dense congenital cataract blocks light during a critical period of visual development, so the priority is to clear the visual axis as early as possible to prevent deprivation amblyopia. The best initial approach is surgical removal of the cataract with immediate optical correction to provide a clear image on the retina, followed by amblyopia therapy to encourage use of the affected eye. Patch therapy alone cannot correct the structural blockage, and observation or delaying surgery allows prolonged deprivation, increasing the risk of irreversible amblyopia. After surgery, refractive correction (often with contact lenses or an intraocular lens, depending on age) and structured amblyopia therapy are essential for optimal visual outcomes.