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Bilateral pediatric cataract surgery: outcomes of 390 children from Nepal and Northern India
Insights
Successful pediatric cataract surgery is achievable in resource-limited settings. Over half of children achieved good vision after bilateral surgery, even with late presentation, demonstrating cost-effective outcomes.
Area of Science:
- Ophthalmology
- Global Health
- Pediatric Surgery
Background:
- Pediatric cataracts pose a significant visual impairment challenge globally.
- Access to specialized surgical care is often limited in resource-constrained regions.
Purpose of the Study:
- To evaluate the outcomes of bilateral pediatric cataract surgery in eastern Nepal and northern India.
- To assess the feasibility and effectiveness of high-volume cataract surgery in underserved populations.
Main Methods:
- Analysis of preoperative, intraoperative, and postoperative data for 390 children undergoing bilateral cataract surgery (2007-2009).
- Inclusion of intraocular lens (IOL) implantation, posterior capsule opening, and anterior vitrectomy in 99% of cases.
- Data collection included visual status, refractive error, and complications.
Main Results:
- The study included 390 children (10.8% from Nepal, 89.2% from India), with a median age of 7 years; 62.3% presented with blindness.
- Over 1 year post-surgery, 53.5% achieved normal visual status (6/6 to 6/18), while 5.6% remained blind.
- Mean refractive error was +1.0 diopters, with astigmatism stabilizing around 1.0 diopter long-term; glaucoma was infrequent.
Conclusions:
- High-volume, cost-effective pediatric cataract surgery is feasible even in resource-limited settings.
- Bilateral surgery, IOL implantation, age-appropriate undercorrection, and provision of spectacles contribute to successful outcomes.
- Despite challenges like late presentation and limited follow-up, over half of the children achieved good visual outcomes, with blindness primarily due to amblyopia or anomalies.
Purpose:
To report the outcomes of bilateral pediatric cataract surgery from eastern Nepal and northern India.
Methods:
Preoperative, intraoperative, and postoperative data of 390 children who underwent surgery bilaterally between 2007 and 2009 were analyzed.
Results:
Forty-two (10.8%) children came from Nepal and 348 (89.2%) from India (mainly Bihar State). Intraocular lens (IOL) implantation with posterior capsule opening and anterior vitrectomy were achieved in 386 (99.0%) children bilaterally. Median age at surgery was 7 years and 69.2% were male. At first presentation, 243 (62.3%) of the children were blind (< 3/60 in the better eye). After more than 1 year, 53.5% had a normal visual status (range: 6/6 to 6/18), 5.6% of children were still blind, and mean refractive error spherical equivalent was +1.0 ± 2.4 diopters. Astigmatism changed from suture-induced with the rule at discharge to against the rule within 3 weeks of surgery. Mean long-term astigmatic error was 1.0 ± 0.9 diopters after 1 year. Glaucoma was rare.
Conclusions:
Even in a setting with limited resources, successful, cost-effective, high-volume surgery for pediatric cataract is possible. Despite late presentation and limited follow-up, more than half achieved good outcomes after more than 1 year. Only 5.6% remained blind due to amblyopia or eye anomalies. Bilateral surgery during one hospital stay, IOL implantation with undercorrection according to age, aggressive surgery to prevent secondary cataract, intensive anti-inflammatory therapy, and provision of durable, high-quality spectacles to take home all proved beneficial because many children cannot attend for regular follow-up.
