Review of childhood cataract surgery at Kikuyu eye unit

Abstract

Objective: To establish the long term outcome of cataract surgery in children below 15 years performed between 1996and 2005at Kikuyu Eye Unit. Methods: This was a retrospective study. We reviewed records of children who under went cataract surgery from January 1996to December 2005at KEU. Results: Nine hundred and fifty three (953) files of patients with childhood cataract (1,514 eyes) were reviewed. 39.3% were female and 60.7%were male. The age range was 2 months to 15 years and the mean 7.4 years. 58.9% had bilateral cataracts while 41.1%were unilateral. The commonest type of cataract operated was congenital cataract. 18.0% of the operated cataracts had past eye disease. 90.7%of those who had past eye disease were due to trauma. 5.9%had other systemic findings of which 21.4% of these were due to congenital rubella syndrome. Pre-operative vision ranged from 6/12 to NPL. 25.2%did not have their vision indicated. 5.6%of the eyes had anterior segment findings and these were due to past trauma. 25% of the eyes had posterior segment findings. The commonest surgical technique used was lensectomy + AV + IOL which accounted for 61.2%. Aphakia was mainly corrected with IOL + spectacles (71.7%).Complications were noted in 788 eyes (52%) operated and included Fibrinoid reaction in 466 eyes (59.2%),PCO in 120 eyes (15.4%)and amblyopia in 36 eyes (4.6%). Other complications were extremely rare. Follow-up was very poor. However, from the few that came for follow-up refractive change (myopic shift) with time was noted in both congenital and traumatic cataract. In both congenital and traumatic cataract vision improved with time. Visual acuity improvement at 6 months was seen to be better in traumatic cataracts than in congenital cataract. Eyes with pre-existing strabismus also showed improvement in visual acuity as well as those with pre-existing nystagmus. The least improvement was seen in eyes with pre-existing microphthalmos. Conclusions: Though it was not possible to accurately determine long term outcome of childhood cataract surgery because of poor follow-up the following observations were made; visual outcome improved with time post-operative in both congenital and traumatic cataract there was myopic shift observed with time in both congenital and traumatic cataract at six months. Children with pre existing nystagmus and strabismus had better visual outcome compared to those with pre existing microphthalmos at six months. Recommendations: In view of the above conclusions the following is recommended; 1. Address barriers to follow-up of children after cataract surgery 2. All children coming with associated ocul•ar finding such as nystagmus and strabismus should be operated on. 3. Whenever you implant an IOL in a child bear in mind that myopic shift will occur.