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Simultaneous bilateral cataract surgery with IOL implantation in children in Kenya
1Eye Unit, PCEA Kikuyu Hospital, Nairobi, Kenya. dsgradin@hotmail.com
Insights
Simultaneous bilateral pediatric cataract surgery is a safe and cost-effective alternative to sequential procedures, with similar outcomes for sight-threatening complications. This approach reduces overall surgical costs for pediatric patients.
Area of Science:
- Ophthalmology
- Pediatric Surgery
- Global Health
Background:
- Congenital and developmental cataracts affect pediatric vision globally.
- Cataract surgery in children requires careful consideration of safety, outcomes, and cost, especially in developing regions.
- Simultaneous bilateral cataract surgery (SBCS) offers potential benefits but requires thorough evaluation.
Purpose of the Study:
- To evaluate the cost-effectiveness, safety, and refractive results of SBCS versus sequential bilateral cataract surgery in pediatric patients.
- To compare postoperative complications and surgical costs in a developing world context.
Main Methods:
- Retrospective study of 96 children (3 months to 10 years) with bilateral cataracts undergoing SBCS or sequential surgery.
- Analysis of cost data, postoperative complications (e.g., fibrin formation, visual axis obstruction), and refractive outcomes.
- Comparison of complication rates, including endophthalmitis and anesthetic-related deaths.
Main Results:
- SBCS reduced total surgical costs by 20.3% compared to sequential surgery ($274 vs. $344 per child).
- No significant difference in fibrin formation (27% vs. 28%) or need for secondary surgery (10.9% overall).
- Low rates of sight-threatening complications: 0.16% for endophthalmitis and 0.11% for anesthetic-related death.
Conclusions:
- Simultaneous bilateral pediatric cataract surgery with intraocular lens implantation is a safe alternative to sequential surgery.
- SBCS offers significant cost reductions without compromising safety or increasing sight-threatening complications.
- This approach is particularly beneficial in resource-limited settings for pediatric cataract management.
Purpose:
To investigate the cost implications, safety, and refractive outcomes of simultaneous bilateral cataract surgery (SBCS) with intraocular lens implantation in pediatric patients in a developing world setting.
Methods:
Children aged 3 months to 10 years with bilateral congenital or developmental cataracts who underwent surgery between January 1, 2007, and December 31, 2009, were eligible for inclusion in this retrospective study. Cost data were compared for simultaneous and sequential cases. Postoperative complications and refraction data were analyzed.
Results:
Ninety-six children (192 eyes) were included, 48 in the SBCS group and 48 in the sequential group. The mean age of the SBCS group and the sequential group was 3.4 and 4.7 years, respectively (P = .04). The total estimated surgical cost was $274 per child for SBCS and $344 for sequential surgery, a reduction of 20.3% for cases of SBCS. Fibrin formation of any amount occurred in 52 of 192 eyes (27.1%), 25 in the SBCS group and 27 in the sequential group (P = .75). Twenty-one eyes (10.9%) had additional surgery to remove visual axis obstruction, 14 in the SBCS group and 7 in the sequential group (P = .11). The incidence of early endophthalmitis in all cases of pediatric cataract surgery in an 11-year period was 0.16%. The incidence of anesthetic-related death during the same period was 0.11%.
Conclusion:
Bilateral simultaneous pediatric cataract surgery with intraocular lens implantation may be a safe alternative to sequential surgery, with advantages in cost reduction and no difference in sight-threatening complications.
