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Mhango PP, Zungu TL, Nkume HI, Musopole A, Mdala SY. The outcomes of paediatric cataract surgery with intraocular lens insertion in sub-Saharan Africa: a systematic review. Syst Rev 2024; 13:204. [PMID: 39095869 PMCID: PMC11295353 DOI: 10.1186/s13643-024-02607-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/13/2023] [Accepted: 07/09/2024] [Indexed: 08/04/2024] Open
Abstract
IMPORTANCE Cataract is one of the leading causes of childhood blindness in Africa. The management of this condition requires timely surgical extraction of the cataractous lens with immediate optical correction and long-term follow-up to monitor visual improvement and manage complications that may arise. This review provides an opportunity to benchmark outcomes and to shed light on the reasons for those outcomes. OBJECTIVES To review the published literature and report on the outcomes of paediatric cataract surgery with intraocular lens insertion in sub-Saharan Africa. DATA SOURCE The EMBASE, PubMed, Scopus, and Web of Science were searched for relevant articles. STUDY SELECTION We included all published primary studies from sub-Saharan Africa on cataract surgery outcomes in children aged 0-16 years with primary intraocular lens implantation conducted between 1990 and 2020. Eligible studies were those published in English or for which an English translation was available. In addition, reviewers screened the reference lists of all studies included in the full-text review for eligible studies. During the review, studies fitting the inclusion criteria above except for having been conducted in middle and high-income countries were tagged and placed in a comparison arm. DATA EXTRACTION AND SYNTHESIS Study eligibility was determined by two independent reviewers, and data extraction was conducted by one reviewer with entries checked for accuracy by another reviewer. Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) guidelines for data synthesis were followed. The Joanna Briggs Institute (JBI) critical appraisal checklist was used for quality appraisal of the studies. The statistical software R was used in the analysis, and data were pooled using a random-effects model. Forest plots were generated using the R package 'metafor'. MAIN OUTCOMES AND MEASURES The primary outcome was visual acuity (VA) after cataract surgery and the proportions of eyes that achieved good, borderline, or poor visual outcome according to the World Health Organisation (WHO) categorisation of post-operative visual acuity. The secondary outcome measures reported included lag time to surgery, rates of follow-up, and rate of complications. RESULTS Eight out of 4763 studies were eligible for inclusion in this review, and seven were included in the quantitative analysis. There was a male preponderance in the study population, and the mean age at the time of cataract surgery ranged from 3.4 to 8.4 years. Visual outcomes were available for short-term visual outcomes (1 to 6 months) as the studies had a significant loss to follow-up. The pooled proportion of eyes that achieved a good visual acuity (i.e. equal to or greater than 6/18) in the short-term period was 31% (CI, 20-42). The comparative studies from middle and high-income countries reported proportions ranging from 41 to 91%, with higher thresholds for good visual acuity of 6/12 and 6/15. CONCLUSION AND RELEVANCE This review reports that there is a lower proportion of eyes with good outcomes after undergoing paediatric cataract surgery in sub-Saharan Africa than in middle- and high-income countries. Furthermore, this review states that there is a high proportion of patients lost to follow-up and suboptimal refractive correction and amblyopia treatment after paediatric cataract surgery.
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Affiliation(s)
- Priscilla Princess Mhango
- Ophthalmology Unit, Department of Surgery, Kamuzu University of Health Sciences (Formerly University of Malawi College of Medicine), P. Bag 360, Blantyre, Malawi.
| | - Thokozani Linda Zungu
- Ophthalmology Unit, Department of Surgery, Kamuzu University of Health Sciences (Formerly University of Malawi College of Medicine), P. Bag 360, Blantyre, Malawi
| | | | - Alinune Musopole
- Department of Biomedical Sciences, Kamuzu University of Health Sciences, Blantyre, Malawi
| | - Shaffi Yusuf Mdala
- Ophthalmology Unit, Department of Surgery, Kamuzu University of Health Sciences (Formerly University of Malawi College of Medicine), P. Bag 360, Blantyre, Malawi
- Queen Elizabeth Central Hospital, Blantyre, Malawi
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Ademola-Popoola D, Muhammad N, Mayor A, Wade P, Ezegwui I, Musa KO, Ugalahi M, Nkanga ED, Udeh N, Ezisi CN, Okeigbemen VW, Dawodu OA, Panshak TE, Okanya CR, Etiowo NM, Sule AA, Obajolowo T, Olusanya B, Muhammad HD. Childhood traumatic cataract in Nigeria; a multicentre study: 2017-2021. Eye (Lond) 2024; 38:2065-2069. [PMID: 37749376 PMCID: PMC11269702 DOI: 10.1038/s41433-023-02749-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2023] [Revised: 08/20/2023] [Accepted: 09/12/2023] [Indexed: 09/27/2023] Open
Abstract
OBJECTIVE To determine the frequency, demography, aetiology and mechanisms of ocular injuries associated with childhood traumatic cataract in Nigeria. METHODS A retrospective multicentre study conducted across ten child eye health tertiary facilities in Nigeria between January 2017 and December 2021. Clinic records of all children aged 0-17 years who had been diagnosed with cataract at the various participating centres were reviewed. Information collected include: biodata, mechanism of injury; laterality, place of injury; object responsible; person responsible; duration before presentation and surgical intervention. RESULTS A total of 636 out of 1656 children (38.4%) had traumatic cataracts during the study period. Their mean age was 109.4 ± 45.2 months with a male-to-female ratio of 2:1. Most injuries were unilateral, two (0.3%) children had bilateral involvement. Only 78 (15.3%) children presented within 4 weeks of the injury. Closed globe injuries were responsible for the traumatic cataract in 475 (74.7%) children, while open globe injuries were more likely to present within 24 h (P < 0.001). The commonest objects of injury were cane, sticks, plant, wood and play materials. Self-inflicted injuries occurred in about 82 (13%) children while 407 (64.0%) were caused by close relatives and contacts. The location where trauma occurred was home in 375 (59.8%) and school in 107 (16.8%) children. CONCLUSION This multicentre study demonstrates that more than one-third of all childhood cataracts in Nigeria are trauma-related and majority are due to closed globe injuries. Public health interventions to reduce the occurrence of ocular trauma and to encourage early presentation after trauma are advocated.
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Affiliation(s)
- Dupe Ademola-Popoola
- Paediatric Unit, Department of Ophthalmology, University of Ilorin & University of Ilorin Teaching Hospital, Ilorin, Nigeria.
| | - Nasiru Muhammad
- Department of Ophthalmology, Usmanu Danfodiyo University & Usmanu Danfodiyo University Teaching Hospital, Sokoto, Nigeria
| | | | - Patricia Wade
- Paediatric Ophthalmology and Strabismus Unit, Department of Ophthalmology, Jos University Teaching Hospital, Katon Rikkos, Plateau State, Nigeria
| | - Ifeoma Ezegwui
- Paediatric Ophthalmology & Strabismus Unit, Department of Ophthalmology, University of Nigeria Teaching Hospital, Ituku-Ozalla, Enugu, Nigeria
| | - Kareem O Musa
- Department of Ophthalmology, Lagos University Teaching Hospital/College of Medicine of the University of Lagos, Idi-Araba, Lagos State, Nigeria
| | - Mary Ugalahi
- Paediatric Ophthalmology and Strabismus Unit, Department of Ophthalmology, University of Ibadan and University College Hospital, Ibadan, Nigeria
| | - Elizabeth Dennis Nkanga
- Calabar Children's Eye Center, Department of Ophthalmology, University of Calabar and University of Calabar Teaching Hospital, Calabar, Cross River State, Nigeria
| | - Nnenma Udeh
- Paediatric Ophthalmology & Strabismus Unit, Department of Ophthalmology, University of Nigeria Teaching Hospital, Ituku-Ozalla, Enugu, Nigeria
| | - Chinyelu N Ezisi
- Paediatric Ophthalmology and Strabismus Unit, Department of Ophthalmology, Alex Ekwueme Federal University Teaching Hospital, Abakaliki, Ebonyi State, Nigeria
| | - Valentina W Okeigbemen
- Paediatric Ophthalmology and Strabismus Unit, Department of Ophthalmology, University of Benin and University of Benin Teaching Hospital, Benin City, Edo State, Nigeria
| | - Oseluese A Dawodu
- Paediatric Ophthalmology and Strabismus Unit, Department of Ophthalmology, University of Benin and University of Benin Teaching Hospital, Benin City, Edo State, Nigeria
| | - Tenmang E Panshak
- Paediatric Ophthalmology and Strabismus Unit, Department of Ophthalmology, Jos University Teaching Hospital, Katon Rikkos, Plateau State, Nigeria
| | - Chinenyenwa R Okanya
- Paediatric Ophthalmology and Strabismus Unit, Department of Ophthalmology, Alex Ekwueme Federal University Teaching Hospital, Abakaliki, Ebonyi State, Nigeria
| | - Nkama M Etiowo
- Calabar Children's Eye Center, Department of Ophthalmology, University of Calabar Teaching Hospital, Calabar, Cross River State, Nigeria
| | - Ademola A Sule
- Department of Ophthalmology, Lagos University Teaching Hospital, Idi-Araba, Lagos State, Nigeria
| | - Tokunbo Obajolowo
- Department of Ophthalmology, University of Ilorin Teaching Hospital, Ilorin, Nigeria
| | - Bolutife Olusanya
- Paediatric Ophthalmology and Strabismus Unit, Department of Ophthalmology, University of Ibadan and University College Hospital, Ibadan, Nigeria
| | - Hassan D Muhammad
- Department of Ophthalmology, Usmanu Danfodiyo University Teaching Hospital, Sokoto, Nigeria
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Nalbandyan M, Howley MM, Cunniff CM, Leckman-Westin E, Browne ML. Descriptive and risk factor analysis of infantile cataracts: National Birth Defects Prevention Study, 2000-2011. Am J Med Genet A 2022; 188:509-521. [PMID: 34687277 PMCID: PMC9969683 DOI: 10.1002/ajmg.a.62546] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2021] [Revised: 09/08/2021] [Accepted: 10/08/2021] [Indexed: 02/05/2023]
Abstract
Using National Birth Defects Prevention Study (NBDPS) data, we sought to estimate birth prevalence, describe clinical characteristics, and examine risk factors for infantile cataracts. We calculated birth prevalence using the numbers of NBDPS-eligible cataract cases and live births in the study area. We described case infants by the presence of associated ipsilateral eye defects (IEDs) and non-eye-related major birth defects. Using maternal exposure information collected via telephone interview, we conducted logistic regression analyses among the interviewed cases and controls. Birth prevalence of infantile cataracts was 1.07/10,000 live births. Unilateral cataracts were more often associated with IEDs, while infants with bilateral cataracts were more often preterm, full-term with low birth weight, or had non-eye-related major birth defects. Unilateral cataracts were positively associated with maternal nulliparity (adjusted odds ratio [aOR] = 1.61, 95% confidence interval [CI] = 1.18, 2.20; reference: multiparity), whereas bilateral cataracts were positively associated with maternal education <12 years (aOR = 2.08, 95% CI = 1.13, 3.82; reference: education >12 years), and foreign-born nativity (aOR = 1.92, 95% CI = 1.04, 3.52; reference: U.S.-born nativity). The current analysis can inform future epidemiological studies aimed at identifying mechanisms underlying the associations between infantile cataracts and complex maternal exposures, such as lower levels of education and foreign-born nativity.
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Affiliation(s)
- Marine Nalbandyan
- Department of Epidemiology and Biostatistics, School of
Public Health, University at Albany, Rensselaer, New York, USA
| | - Meredith M. Howley
- Birth Defects Registry, New York State Department of
Health, Albany, New York, USA
| | | | - Emily Leckman-Westin
- Department of Epidemiology and Biostatistics, School of
Public Health, University at Albany, Rensselaer, New York, USA,New York State Office of Mental Health, Albany, New York,
USA
| | - Marilyn L. Browne
- Department of Epidemiology and Biostatistics, School of
Public Health, University at Albany, Rensselaer, New York, USA,Birth Defects Registry, New York State Department of
Health, Albany, New York, USA
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Ezeh E, Nkanga E, Okonkwo S, Agweye C, Ibanga A, Nkanga D. Paediatric cataracts in a tertiary eye centre in South-South Nigeria: An initial audit of surgical outcome. NIGERIAN JOURNAL OF MEDICINE 2022. [DOI: 10.4103/njm.njm_40_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
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Limitations in cataract surgical services for children in Ethiopia: a nationwide survey of pediatric cataract surgeons. BMC Ophthalmol 2021; 21:437. [PMID: 34923960 PMCID: PMC8684671 DOI: 10.1186/s12886-021-02190-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2021] [Accepted: 11/17/2021] [Indexed: 11/28/2022] Open
Abstract
Background Bilateral cataract is a significant cause of blindness in children in Ethiopia. This study aimed to identify the resources available for cataract surgery in children, and to assess current surgical practices, surgical output and factors affecting the outcome of surgery in Ethiopia. Methods A Google Forms mobile phone questionnaire was emailed to nine ophthalmologists known to perform cataract surgery in young children (0–5 years). Results All nine responded. All but one had received either 12- or 3–5-month’s training in pediatric ophthalmology with hands-on surgical training. The other surgeon had received informal training from an experienced colleague and visiting ophthalmologists. The surgeons were based in seven health facilities: five in the capital (Addis Ababa) and eight in six public referral hospitals and one private center. Over 12 months (2017–2018) 508 children (592 eyes) aged 0–18 years (most < 15 years) were operated by these surgeons. 84 (17%) had bilateral cataract, and 424 (83%) had unilateral cataract mainly following trauma. A mean of 66 (range 18–145) eyes were operated per surgeon. Seventy-one additional children aged > 5 years were operated by other surgeons. There were substantially fewer surgeons per million population (nine for 115 million population) than recommended by the World Health Organization and they were unevenly distributed across the country. Methylcellulose and rigid intraocular lenses were generally available but less than 50% of facilities had a sharp vitrectomy cutter and cohesive viscoelastic. Mean travel time outside Addis Ababa to a facility offering pediatric cataract surgery was 10 h. Conclusion Despite the high number of cases per surgeon, the output for bilateral cataracts was far lower than required. More well-equipped pediatric ophthalmology teams are urgently required, with deployment to under-served areas.
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Ben-Zion I, Prat D. The impact of late-treated pediatric cataract on intraocular pressure. Int Ophthalmol 2021; 41:1531-1539. [PMID: 33471248 DOI: 10.1007/s10792-021-01727-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2020] [Accepted: 01/11/2021] [Indexed: 11/25/2022]
Abstract
PURPOSE To assess the intraocular pressure and visual acuity before and after pediatric congenital cataract surgery performed at a relatively older age. METHODS A retrospective analysis of all consecutive pediatric patients diagnosed and operated for bilateral congenital cataracts during a seven-year period (2012-2018) in rural southern Ethiopia. Non-ambulatory vision was defined as hand motion or worse. The main outcome measures were intraocular pressure (IOP) and visual acuity. RESULTS Thirty-two children were included, 17 females (53.1%), with a mean age of 11 years (± 2.83) [range, 7-18]. A total of 59 eyes were operated on. The mean follow-up was 4.8 ± 1.8 years (range, 2-8). VA improved from 20/1400 preoperatively to 20/440 postoperatively OD and 20/540 OS (p < 0.001). More eyes had ambulatory vision after cataract surgery than pre-surgery (56 eyes [95%] vs. 29 eyes [49%], p < 0.001). The IOP decreased from a mean preoperative value of 18.4 ± 7.1 mmHg to 14.5 ± 2.9 postoperatively OD (p < 0.001) and 16.3 ± 5.9 mmHg to 13.9 ± 3.5 OS (p < 0.001). Fifteen eyes (24%) had increased IOP (> 21 mmHg) preoperatively, of which three remained high after surgery. Positive correlations were found between IOP, axial length and cup-to-disc ratio. None of the patients required pressure-lowering procedures. CONCLUSION Bilateral congenital cataracts may be associated with ocular hypertension, with possible progression to glaucoma if left untreated. Surgery at a relatively older age often was associated with a significant improvement in intraocular pressure and ambulatory vision.
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Affiliation(s)
- Itay Ben-Zion
- Ophthalmology Department, Padeh Medical Center, Poriya, Israel, affiliated With Bar-Ilan Faculty of Medicine, Safed, Israel.
| | - Daphna Prat
- Goldschleger Eye Institute, Faculty of Medicine, Sheba Medical Center, Tel Hashomer, Israel, affiliated With Sackler, Tel Aviv University, Tel Aviv, Israel
- Division of Ophthalmology, The Children's Hospital of Philadelphia, Philadelphia, PA, USA
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Ugalahi MO, Olusanya BA, Aremu OO, Baiyeroju AM. Outcome of surgery for traumatic cataract in children in a child eye health tertiary facility, Ibadan, Nigeria. Ther Adv Ophthalmol 2021; 13:25158414211005308. [PMID: 35187399 PMCID: PMC8855383 DOI: 10.1177/25158414211005308] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2020] [Accepted: 03/04/2021] [Indexed: 11/16/2022] Open
Abstract
Objective: The objective of this study was to describe the outcome of surgery for traumatic cataract and associated factors in children aged 16 years and below operated in a tertiary facility. Methods: This was a retrospective review of records of children who had surgery for traumatic cataract between August 2015 and August 2019. Information on biodata, preoperative visual acuity, surgical methods, complications, and postoperative visual acuity were retrieved. Data were analyzed using IBM SPSS Statistics 20.0. Results: Traumatic cataract accounted for 87 (14.7%) of 593 eyes operated for childhood cataract during the period. Of these, a total of 79 records were available for review. There were 56 (70.9%) males with a mean age of 10.11 (±3.39) years. All injuries were unilateral; closed globe injuries accounted for 70 (88.8%) of the cataracts and the left eye was affected in 42 (53.2%) patients. Fifty-two (67.09%) eyes had other ocular injuries apart from cataracts. The morphology of the cataract was membranous in 44 (55.7%) eyes, and 76 (96.2%) eyes had cataract surgery with intraocular lens (IOL) implantation; 39 (51.3%) of these IOLs were implanted within the capsular bag. The preoperative best corrected visual acuity was worse than 6/18 in all 79 (100%) eyes and improved to 6/18 or better in 32 (40.5%) eyes at 3 months postoperatively. Conclusion: Traumatic cataract accounted for less than a quarter of all childhood cataracts in our center. Majority of the eyes had successful IOLs implantation during surgery, and the best corrected visual acuity improved in a moderate proportion of these patients.
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Affiliation(s)
- Mary Ogbenyi Ugalahi
- Department of Ophthalmology, College of Medicine and University College Hospital, University of Ibadan, Ibadan, Nigeria
| | - Bolutife Ayokunnu Olusanya
- Department of Ophthalmology, College of Medicine and University College Hospital, University of Ibadan, Ibadan 200212, Oyo State, Nigeria
| | | | - Aderonke Mojisola Baiyeroju
- Department of Ophthalmology, College of Medicine and University College Hospital, University of Ibadan, Ibadan, Nigeria
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Ngoy JK, Stahnke T, Dinkulu S, Makwanga E, Moanda A, Ngweme G, Mukwanseke E, Kundt G, Thiesen F, Hopkins A, Guthoff RF. Bilateral paediatric cataract surgery - outcomes of 298 children from Kinshasa, the Democratic Republic of the Congo. Afr Health Sci 2020; 20:1817-1827. [PMID: 34394244 PMCID: PMC8351814 DOI: 10.4314/ahs.v20i4.36] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
INTRODUCTION The leading cause of childhood blindness globally is paediatric cataract. Bilateral cataract surgery can help to improve visual performance and to diminish the burden of childhood blindness. OBJECTIVE To report in a retrospective observational cohort study the long-term outcomes of 298 children who had bilateral cataract surgery with IOL implantation from 2001-2016 in Kinshasa. METHODS A standardized surgical treatment of paediatric cataract was practiced on 298 children. Patient's follow-up, complications, and visual outcomes were recorded and analysed. RESULTS The mean age was 5.7 ± 4.3 years and males were predominant (64.9%). Most of children were living mainly in urban poorest areas (96.3%). Strabismus, nystagmus and microcornea were encountered in 20.1%, 25.1% and 8.7% of children, respectively. Using WHO criteria most of patients were classified as blind preoperatively and 81.9% of them had improved visual outcomes after surgery. Main reasons for reduced vision during follow-up were secondary cataract (5.7%), IOL decentration (1.2%), retinal detachment (1.2%), and secondary glaucoma (1.5%). CONCLUSION In spite of the post conflict challenges, elimination of cataract blindness in children remains a priority. Children present at a late age for surgery and long term follow-up is poor. There is need for program strengthening in these areas.
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Affiliation(s)
- Janvier Kilangalanga Ngoy
- Eye Department, St Joseph Hospital/CFOAC, Kinshasa, DRC
- Rostock University Medical Center, Department of Ophthalmology, Rostock, Germany
- Programme National de Sante Oculaire et Vision (PNSOV), Kinshasa, DRC
- Réhabilitation à Assise Communautaire (RAC/CBR), Kinshasa, DRC
- Rostock University Medical Center, Institute for Biostatistics and Informatics in Medicine and Ageing Research, Rostock, Germany
| | - Thomas Stahnke
- Rostock University Medical Center, Department of Ophthalmology, Rostock, Germany
| | - Serge Dinkulu
- Eye Department, St Joseph Hospital/CFOAC, Kinshasa, DRC
| | - Emile Makwanga
- Programme National de Sante Oculaire et Vision (PNSOV), Kinshasa, DRC
| | - Astrid Moanda
- Réhabilitation à Assise Communautaire (RAC/CBR), Kinshasa, DRC
| | | | | | - Günther Kundt
- Rostock University Medical Center, Institute for Biostatistics and Informatics in Medicine and Ageing Research, Rostock, Germany
| | - Frank Thiesen
- Rostock University Medical Center, Institute for Biostatistics and Informatics in Medicine and Ageing Research, Rostock, Germany
| | - Adrian Hopkins
- Programme National de Sante Oculaire et Vision (PNSOV), Kinshasa, DRC
| | - Rudolf F Guthoff
- Rostock University Medical Center, Department of Ophthalmology, Rostock, Germany
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Mndeme FG, Mmbaga BT, Msina M, Mwende J, Vaitha SJ, Kim MJ, Macleod D, Burton MJ, Gilbert CE, Bowman R. Presentation, surgery and 1-year outcomes of childhood cataract surgery in Tanzania. Br J Ophthalmol 2020; 105:334-340. [PMID: 32522793 PMCID: PMC7907562 DOI: 10.1136/bjophthalmol-2020-316042] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2020] [Revised: 03/30/2020] [Accepted: 04/23/2020] [Indexed: 11/04/2022]
Abstract
Background Recent reports have suggested a significant change in the causes of blindness in children in low-income countries cataract becoming the leading cause. We aimed to investigate the presentations and surgical outcomes in children with cataract operated at different ages in Tanzania. Methods We conducted a prospective study of 228 children aged ≤192 months at three tertiary centres, 177 with bilateral cataracts and prospectively followed them for 1-year postsurgery. We collected demographic, surgical, preoperative and postoperative clinical characteristics using the standard childhood cataract surgical assessment questionnaire. Families were encouraged to return for follow-up by phone with travel reimbursement where necessary. Results Preoperatively, 76% bilateral children were blind in the better eye. 86% of children were followed up at 1 year and 54% bilateral children achieved visual acuity of 0.48 logMAR or better in the better eye and 5% were blind. 33% of unilateral children achieved visual acuity of 0.48 logMAR or better and 17% were blind. Preoperative blindness (adjusted OR (AOR) 14.65; 95% CI 2.21 to 97.20), preoperative nystagmus/strabismus (AOR 9.22; 95% CI 2.66 to 31.97) and aphakia (AOR, 5.32; 95% CI 1.05 to 26.97) predicted poor visual outcome in bilateral cases. 9% of 342 refracted eyes had initial postoperative cylinder of 1.5 D or more, as did a similar proportion (11%) of 315 eyes refracted 1 year after surgery. Acute fibrinous uveitis occurred in 41 (12%) eyes. Conclusion Three-quarters of children were blind preoperatively whereas over half had good vision 1-year postoperatively. Preoperative blindness, nystagmus/strabismus and aphakia predicted poor visual outcome, suggesting that cataract density determines density of amblyopia.
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Affiliation(s)
- Furahini Godfrey Mndeme
- Ophthalmology, Kilimanjaro Christian Medical University Collage, Moshi, Tanzania, United Republic of .,Clinical Research, London School of Hygiene and Tropical Medicine, London, UK
| | - Blandina Theophyl Mmbaga
- Paediatrics, Kilimanjaro Clinical Research Institute, Kilimanjaro Christian medical Centre, Moshi, Tanzania, United Republic of
| | - Mchikirwa Msina
- Ophthalmology, Kilimanjaro Christian Medical University Collage, Moshi, Tanzania, United Republic of
| | - Judith Mwende
- Ophthalmology, Muhimbili National Hospital, Dar-Es-Salaam, Dar-Es-Salaam, Tanzania, United Republic of
| | - Sonia J Vaitha
- Ophthalmology, Comprehensive Community Based Rehabilitation in Tanzania, Dar-Es-Salaam, Tanzania, United Republic of
| | - Min J Kim
- Tropical Epidemiology Group, Faculty of Infectious Disease Epidemiology, London School of Hygiene and Tropical Medicine, London, London, UK
| | - David Macleod
- Tropical Epidemiology Group, Faculty of Infectious Disease Epidemiology, London School of Hygiene and Tropical Medicine, London, London, UK.,Medical Statistics, London School of Hygiene & Tropical Medicine, London, UK
| | - Matthew J Burton
- Clinical Research, London School of Hygiene and Tropical Medicine, London, UK
| | - Clare E Gilbert
- Clinical Research, London School of Hygiene and Tropical Medicine, London, UK
| | - Richard Bowman
- Clinical Research, London School of Hygiene and Tropical Medicine, London, UK.,Ophthalmology, Great Ormond Street Hospital, London, UK
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Jamison A, Mackinnon JR, Lavy TE, Manda C, Msukwa G. Establishing a Pediatric Ophthalmology Service in Malawi: Developments in Childhood Cataract Surgery. Middle East Afr J Ophthalmol 2019; 26:77-82. [PMID: 31543664 PMCID: PMC6737779 DOI: 10.4103/meajo.meajo_35_18] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
PURPOSE: The purpose of this study is to report on the establishment of a Pediatric Ophthalmology Service for Malawi using childhood cataract surgery as a surrogate measure of its effectiveness. MATERIALS AND METHODS: A retrospective review of pediatric cataract surgery at Lions Sight First Eye Hospital, Blantyre, between 2011 and 2016. The paucity of comprehensive records allowed for the sampling of a maximum of 25 cases/year (n = 150) for comparison. Theatre records and population statistics were used to calculate childhood cataract surgical rates (CCSR). RESULTS: A total of 949 cataract operations were performed during the six years studied – 55.8% of these were boys. The number of operations per year remained generally stable. Of the 150 cases reviewed, the mean age at presentation was 6.01 years, with a trend toward a slightly younger age over the period. Over the years studied, the geographical distribution of referrals became more reflective of the population's distribution. Where the logarithm of the minimum angle of resolution (LogMAR) visions were available, these demonstrated a mean improvement from 2.008 (n = 43) preoperatively to 0.613 (n = 51) postoperatively. The mean follow-up was 106 days (0 days–3.25 years). Complication rates were low. The CCSR was 9.2/million population. CONCLUSIONS: A Pediatric Ophthalmology Service has been established in Malawi delivering safe, effective surgery on a country-wide scale for childhood cataract. Over the period studied, the age at presentation reduced, and there was an improvement in the geographical distribution of patients, likely due to an improvement in referral systems throughout Malawi.
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Affiliation(s)
- Aaron Jamison
- Vision 2020 Glasgow-Blantyre Link, Glasgow Team, Scotland, UK
| | | | - Timothy E Lavy
- Vision 2020 Glasgow-Blantyre Link, Glasgow Team, Scotland, UK
| | - Chatonda Manda
- Lions Sight First Eye Hospital, Queen Elizabeth Central Hospital, Blantyre, Malawi
| | - Gerald Msukwa
- Lions Sight First Eye Hospital, Queen Elizabeth Central Hospital, Blantyre, Malawi
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