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Outcomes of bilateral cataract surgery in Tanzanian children
Richard J C Bowman1, Joy Kabiru, Guy Negretti
1Comprehensive Community-Based Rehabilitation for Tanzania Disability Hospital, Dar es Salaam, Tanzania.
Insights
Outcomes of bilateral pediatric cataract surgery in East Africa show that preoperative blindness significantly predicts poor visual results. AcrySof intraocular lenses improved fixation and reduced astigmatism compared to polymethyl methacrylate lenses.
Area of Science:
- Ophthalmology
- Pediatric Surgery
- Global Health
Background:
- Cataract surgery in children presents unique challenges.
- Understanding surgical outcomes in resource-limited settings is crucial for improving pediatric eye care.
- East Africa faces a significant burden of childhood visual impairment.
Purpose of the Study:
- To investigate the outcomes of bilateral pediatric cataract surgery in East Africa.
- To identify factors influencing visual results after surgery in children.
- To compare the performance of different intraocular lens types.
Main Methods:
- Retrospective interventional case series of 243 children undergoing bilateral cataract surgery.
- Data collected included demographic, surgical, preoperative, and postoperative clinical characteristics.
- Statistical analysis was performed to identify predictors of visual outcome and refractive error.
Main Results:
- 62% of patients achieved 20/60 or better in their better eye; 13% remained blind.
- Absence of preoperative blindness was the strongest predictor of good visual outcome (OR, 7.3).
- AcrySof intraocular lenses were associated with better in-the-bag fixation and reduced postoperative astigmatism compared to polymethyl methacrylate (PMMA) lenses.
Conclusions:
- Preoperative blindness is a critical factor for poor visual outcomes in pediatric cataract surgery.
- AcrySof intraocular lenses demonstrate advantages over PMMA lenses in terms of fixation and astigmatism reduction.
- Optimizing surgical techniques and lens choices can improve visual rehabilitation for children in East Africa.
Objective:
To investigate outcomes of bilateral pediatric cataract surgery in east Africa.
Design:
Retrospective interventional case series.
Participants:
Two hundred forty-three children who underwent bilateral cataract surgery at the Comprehensive Community-Based Rehabilitation for Tanzania Disability Hospital between 2001 and 2004.
Methods:
Demographic, surgical, preoperative, and postoperative clinical characteristics obtained from patient records were entered into a database (Microsoft Excel; Microsoft, Redmond, WA), and statistical analysis was conducted using SPSS software for Windows (SPSS, Inc., Chicago, IL).
Main Outcome Measures:
Postoperative visual acuities and factors affecting them and postoperative refraction results.
Results:
Intraocular lenses were inserted in the first eyes of 232 children (149 Alcon AcrySof [Alcon Laboratories, Fort Worth, TX], 83 polymethyl methacrylate [PMMA]). Fifty-eight (62%) of 94 patients with final follow-up acuities recorded in both eyes achieved 20/60 or better in their better eye and 13 (13%) of 94 patients were blind. Of the various predictors of good visual outcome identified for children or eyes, only absence of preoperative blindness (odds ratio [OR], 7.3; 95% confidence interval [CI], 3.0-18.0; P<0.0005) remained significant in a multivariate logistic regression model. One hundred nine (51%) of 212 refracted first eyes had early postoperative refractive error spherical equivalent magnitudes of 2 diopters (D) or more. Ninety-nine (47%) of 212 eyes had initial postoperative cylinders of 3 D or more, dropping to 30 (18%) of 164 of those who had later follow-up refraction. Presence of biometric data was not associated with smaller postoperative refractive errors. Eyes with AcrySof lenses were less likely (OR, 2.5; 95% CI, 1.04-6.06) to have more than 3 D of astigmatism at latest follow-up. AcrySof lenses also were more likely (OR, 2.1; 95% CI, 1.2-3.7) to be fixated in the bag than PMMA lenses. Acute fibrinous uveitis occurred in 30 cases (12%), and transient corneal haze occurred in 20 cases (8%). Twenty-seven (11%) had chronic complications, 69 (28%) underwent a further general anesthetic procedure, and 9 (4%) underwent yytrium-aluminum-garnet capsulotomy.
Conclusions:
Preoperative blindness was the strongest predictor of poor postoperative visual outcome; the use of AcrySof lenses as opposed to PMMA lenses made in-the-bag fixation more likely and also reduced postoperative astigmatism.