Outcome of childhood cataract surgery at Sabatia eye hospital

Abstract

Background: - Cataract is the most common cause of blindness in children in the developing countries. It is largely reversible and is one of the main targets for treatment in the WHO elimination of preventable blinding diseases. Cataract surgery outcome in children is poorer than adults in Africa. Few studies have been done to determine outcomes in Kenya and none had been done at Sabatia Eye Hospital, an eye hospital located in Western Kenya. Objectives: - The aim of this study was to determine the outcome of cataract surgery both in the intraoperative and postoperative period. Methodology: - Study Design: This was a retrospective case series study done at Sabatia Eye Hospital reviewing all records of children aged less than 15years who underwent cataract surgery in 2012. Study duration:-January2013 to February 2014. Study Variables: -Intra-operative and postoperative complications, visual acuity and refractive status outcome of cataract surgery and associated factors up to 6 months after the surgery. Data Management: -Descriptive analysis was undertaken to determine outcomes. Proportionate test was used to compare proportions. Chi-square was used to test factors associated with poor outcome. Results:- A total of 90 patients (123 eyes) were included in the study, 62.2% of them being male and female at 37.8 %, this was a statistically significant sex difference (p-value<0.001). Pre-operatively, 61eyes (49.59%) were blind (WHO Visual Acuity <3/60). There was a xi long delay between onset and presentation with a mean duration of 40.23months (1-168mnths) for congenital and 29.37months (2-168mnths) for developmental cataract. A majority of the cases – 92eyes underwent Lens Washout with Primary Posterior Capsulotomy, Anterior Vitrectomy and Intraocular Lens Placement. Of note, 91.06% had Primary IOL placement. Intraoperative complications were seen in 12 (9.76%) eyes. Late refraction findings showed a mean absolute spherical refractive error of 3.51D (mean of 2.61D in those who had biometry) and cylindrical error mean of 1.80D. Poor visual outcome at 12+weeks was 32.26% with Ambylopia being commonest cause of poor vision. Commonest early complication was corneal haze in 25 eyes (20.33%) and late (12+weeks) was PCO noted in 26.67%, Pupillary abnormality (37.78%) and Ambylopia (24.44%). Congenital cataracts was associated with a worse outcome than developmental cataract, OR 0.19(0.03-1.17),(p-value=0.0444). Conclusion:- Majority of the children had good or borderline visual acuity outcome, with poor outcome also noted in some due to various factors. The rate of complications was similar to other studies. Corneal haze was the commonest early complication while pupillary abnormality, Ambylopia and PCO were the most common later complications. Refractive outcome was better and less variable in patients who had biometry before surgery. Congenital cataract had poorer outcome. Ambylopia was the commonest cause of poor vision.