[Cataract surgery in sub-Saharan Africa-Possibilities and limits]

The importance of cataract surgery for the treatment of visual impairment and blindness is as uncontroversial as the cost-effectiveness of the procedure. In terms of quality, there are almost no published case series of cataract operations in sub-Saharan Africa that meet the World Health Organization (WHO) guidelines for postoperative visual acuity.

The results after cataract surgery at a publicly accessible tertiary care eye clinic in Rwanda are presented and compared with standardized results from an eye clinic in Germany (AKW).

Data from 100 consecutive eyes (manual small incision cataract surgery, MSICS-Rwanda, Phaco-Rwanda, Phaco-AKW) were retrospectively evaluated. The results were compared with each other and with WHO guidelines.

The number of patients with significantly reduced preoperative visual acuity (visual acuity > 1.3 logMAR) was highest in the MSICS group (MSICS 92%, Phaco-Rwanda 13%, Phaco-AKW 1%). Uncorrected postoperative visual acuity was similar in the Phako-Rwanda and Phako-AKW groups (0.22/0.21 logMAR) and better than MSICS Rwanda (0.33 logMAR). The best corrected postoperative visual acuity was significantly better in the Phako-Rwanda group (0.07 logMAR) than in the two comparison groups Phako-AKW (0.1 logMAR) and MSICS Rwanda (0.15 logMAR). The results of all three groups fulfilled the WHO criteria for postoperative visual acuity.

Despite poor initial visual acuity, high quality results can be achieved in cataract surgery in a clinical setting in sub-Saharan Africa that are within WHO expectations. A coexistence of MSICS technique and phaco seems reasonable to avoid complications and achieve the best possible results.