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Ugalahi M, Adediran O, Olusanya B, Baiyeroju A. Management of childhood cataract: practice patterns among ophthalmologists in Nigeria. Eye (Lond) 2023:10.1038/s41433-023-02755-x. [PMID: 37749375 DOI: 10.1038/s41433-023-02755-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2023] [Revised: 09/08/2023] [Accepted: 09/13/2023] [Indexed: 09/27/2023] Open
Abstract
OBJECTIVE To describe the practice patterns for the management of paediatric cataracts among ophthalmologists practising in Nigeria. METHODS A cross-sectional study of fully trained Nigerian ophthalmologists who perform cataract surgery in children aged 16 years and below. An online questionnaire was distributed via e-mail and social media platforms to respondents. Data on socio-demographic characteristics, type, location and years of practice, status and preferred approach to management of childhood cataracts were obtained and analysed. RESULTS A total of 41 ophthalmologists responded that they perform paediatric cataract surgery. Of these, 25 (61.0%) were paediatric ophthalmologists while 7 (17.0%) were general ophthalmologists. Most respondents (92.7%) practise in urban settings and 30 (73.2%) work in tertiary hospitals. Most respondents (90.2%) routinely insert intraocular lenses (IOLs) in children aged 2 years and above while 32 (78.0%) routinely under-correct the IOL power. Thirty-four (82.9%) have an anterior vitrectomy machine, 31 (75.6%) routinely perform posterior capsulotomy and anterior vitrectomy, and 17 (58.5%) routinely perform same-day sequential bilateral cataract surgery. Twenty-six (63.4%) respondents routinely give near correction in aphakic children, while 24 (58.5%) respondents routinely give bifocals in pseudophakic children. Compared to other sub-specialists, paediatric ophthalmologists were 24 times more likely to routinely under-correct IOL power (p = 0.001) and 4 times more likely to routinely correct near vision in aphakic children (0.036) as well as prescribe bifocals for pseudophakic children respectively (0.029). CONCLUSION The practice of paediatric cataract surgery in Nigeria is mainly in line with expected standards, but there is a need for the development of detailed practice guidelines.
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Affiliation(s)
- Mary Ugalahi
- Department of Ophthalmology, College of Medicine, University of Ibadan and University College Hospital, Ibadan, Nigeria
| | | | - Bolutife Olusanya
- Department of Ophthalmology, College of Medicine, University of Ibadan and University College Hospital, Ibadan, Nigeria.
| | - Aderonke Baiyeroju
- Department of Ophthalmology, College of Medicine, University of Ibadan and University College Hospital, Ibadan, Nigeria
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Sayadi J, Malek I, Sammouda T, Choura R, Mekni M, Zghal I, Khairallah M, Nacef L. Clinical features and outcomes of congenital cataract surgery with primary intraocular lens implantation in a tunisian cohort. J Curr Ophthalmol 2022; 34:187-193. [PMID: 36147275 PMCID: PMC9486992 DOI: 10.4103/joco.joco_273_21] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2021] [Revised: 11/08/2021] [Accepted: 11/12/2021] [Indexed: 11/18/2022] Open
Abstract
Purpose: To describe the clinical features of congenital cataract (CC) in a Tunisian cohort and to assess the surgical outcomes of primary intraocular lens implantation in two groups based on the age at surgery. Methods: This study was a prospective analysis of children under 5 years with CC that were operated between January 2015 and 2020. The surgery consisted of phacoaspiration with posterior capsulorhexis and primary implantation. Group 1 comprised children operated at <2 years of age and Group 2 comprised children operated between 2 and 5 years. Peri and postoperative surgical events as well as refractive and visual outcomes were compared between both the groups. Results: Fifty-five (84 eyes) infants were enrolled. Group 1 included 30 (48 eyes) children and Group 2 included 25 (36 eyes) patients. The mean follow-up was 27.60 ± 19.89 months. The mean delay between the diagnosis and the cataract surgery was 11.97 ± 13.84 months. Of 14 (16.7%) eyes with postoperative visual axis opacification (VAO), 9 (10.7%) eyes required pars plana membranectomy. The VAO was not statistically associated with the age at surgery (P = 0.112), but significantly correlated with sulcus implantation (P = 0.037). The final mean visual acuity was 0.51 logMAR and comparable between both the groups (P = 0.871). Poor visual outcome was significantly associated with low age at presentation (<6 months; P = 0.039), delay between the diagnosis and time of surgery (P = 0.001), preoperative nystagmus (P = 0.02), and poor parental compliance to amblyopia treatment (P = 0.009). Conclusions: Primary implantation seems to be safe and efficient. VAO appears to become an avoidable occurrence owing to better surgical techniques. Amblyopia remains the biggest barrier to final visual outcome.
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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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AYGIT ED. Kongenital katarakt vaka serisi. EGE TIP DERGISI 2021. [DOI: 10.19161/etd.990221] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
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Musa K, Agboola S, Sam-Oyerinde O, Salako S, Kuku C, Uzoma C. Pattern of congenital ocular anomailes among children seen at a West African tertiary eye care centre: A retrospective study. JOURNAL OF CLINICAL SCIENCES 2021. [DOI: 10.4103/jcls.jcls_48_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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Olowoyeye AO, Musa KO, Aribaba OT. Outcome of training of maternal and child health workers in Ifo Local Government Area, Ogun State, Nigeria, on common childhood blinding diseases: a pre-test, post-test, one-group quasi-experimental study. BMC Health Serv Res 2019; 19:430. [PMID: 31248402 PMCID: PMC6598310 DOI: 10.1186/s12913-019-4272-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2018] [Accepted: 06/17/2019] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Maternal and child health workers (MCHWs) are often the first point of contact with pregnant women, children, and caregivers. Therefore, they can play a significant role in early detection of causes of childhood blindness, facilitate prompt referral to specialized centers and provide health education to caregivers for preventive eye care. METHODS This is a pre-test, post-test, single group, quasi-experimental study to evaluate the outcome of training MCHWs on common blinding childhood diseases. All MCHWs in Ifo Local Government Area were selected to participate in the study. Pre-training, qualitative data was obtained from two focus group discussions while quantitative data was obtained using a self-administered questionnaire. Three months post-training, quantitative data was obtained using the same self-administered questionnaire as was used pre-training. Total and percentage scores on the pre- and post-tests were calculated for each participant. A score of ≥70% was regarded as sufficient while < 70% score was regarded as insufficient. McNemar's test was used to determine differences in proportions between pre- and post-training quantitative measurements. RESULTS Of the 65 MCHWs in the Local Government Area, 61 participated in the study giving a response rate of 93.8%. The age range of study participants was from 28 to 57 years with a mean age of 41 ± 8.3 years. The male: female ratio was 1:7.7. During the focus group discussions, measles was the most commonly mentioned cause of childhood blindness however, participants showed more knowledge of the signs and symptoms of new-born conjunctivitis. Based on a sufficient knowledge score of ≥70%, only one participant (1.6%) demonstrated sufficient knowledge on quantitative survey pre-training. Post-training, there was a statistically significant increase (20, 32.8%) in the proportion of participants with sufficient knowledge (McNemar's test p = .000). CONCLUSIONS This study demonstrated that the training of MCHWs on common childhood blinding diseases (such as congenital cataract and congenital glaucoma) had the potential to improve knowledge regarding prevention, prompt recognition and early referral of common treatable potentially blinding diseases.
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Affiliation(s)
| | - K O Musa
- Department of Ophthalmology (Guinness Eye Center), Lagos University Teaching Hospital/ College of Medicine of the University of Lagos, Idi-Araba, Lagos, Nigeria
| | - O T Aribaba
- Department of Ophthalmology (Guinness Eye Center), Lagos University Teaching Hospital/ College of Medicine of the University of Lagos, Idi-Araba, Lagos, Nigeria
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Ugalahi MO, Olusanya BA, Fagbemi OO, Baiyeroju AM. Delays in uptake of surgery for childhood cataract at a child eye health tertiary facility in sub-Saharan Africa. Eur J Ophthalmol 2019; 30:280-283. [PMID: 30747005 DOI: 10.1177/1120672119827770] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Timely uptake of surgery is vital in the control of childhood blindness due to cataract. The aim of this study is to determine the uptake of surgery as well as the frequency and reasons for rescheduling of surgery for childhood cataract in a tertiary hospital in southwest Nigeria. METHODS A retrospective study of children with childhood cataract seen at the Paediatric Ophthalmology unit of the University College Hospital, Ibadan between 2011 and 2015. Demographic and clinical information was retrieved from case records. Caregivers of children who did not have surgery were contacted by telephone to elicit reasons why surgery was not done. RESULTS A total of 164 children were included in the study; 90 (54.9%) were male. The median age at presentation was 4 years with a range of 2-180 months. A total of 64 (39.0%) children had unilateral cataract. All patients were scheduled for surgery, but 123 (75%) underwent surgery. Surgery was rescheduled in 42 (34.1%) of those who had surgery. Reasons for rescheduling included financial constraints, illness, delay in paediatrician evaluation to ascertain fitness for anaesthesia and strike actions by health workers in the hospital. CONCLUSION Three quarters of the children had surgery, though it had been rescheduled, at least once, in about one-third of them. Delayed uptake of surgery was mainly due to inability to afford treatment and strike actions. The need for improved coverage of health insurance especially for the paediatric age group in developing countries cannot be overemphasized. This is because good vision is an integral part of child development.
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Affiliation(s)
- M O Ugalahi
- Department of Ophthalmology, College of Medicine, University of Ibadan, Ibadan, Nigeria.,Department of Ophthalmology, University College Hospital, Ibadan, Nigeria
| | - B A Olusanya
- Department of Ophthalmology, College of Medicine, University of Ibadan, Ibadan, Nigeria.,Department of Ophthalmology, University College Hospital, Ibadan, Nigeria
| | - O O Fagbemi
- Department of Ophthalmology, University College Hospital, Ibadan, Nigeria
| | - A M Baiyeroju
- Department of Ophthalmology, College of Medicine, University of Ibadan, Ibadan, Nigeria.,Department of Ophthalmology, University College Hospital, Ibadan, Nigeria
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Asferaw M, Mekonen SY, Woodruff G, Gilbert CE, Tesfaye S. Outcome of paediatric cataract surgery in Northwest Ethiopia: a retrospective case series. Br J Ophthalmol 2018; 103:112-118. [PMID: 29669781 DOI: 10.1136/bjophthalmol-2017-311513] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2017] [Revised: 03/06/2018] [Accepted: 03/12/2018] [Indexed: 11/04/2022]
Abstract
AIM To assess visual acuity outcomes, and factors associated with the outcome, of paediatric cataract surgery at the Child Eye Health Tertiary Facility, Gondar, Northwest Ethiopia. METHODS The medical records of children aged below 16 years who underwent cataract surgery between September 2010 and August 2014 were reviewed for preoperative, surgical and postoperative data. RESULTS One hundred and seventy-six eyes of 142 children (mean age 7.9 years±4.2 SD, 66% male) who had cataract surgery were included. Twenty-five per cent (35/142) of children had bilateral cataract, 18 (13%) had unilateral non-traumatic cataracts and 89 (63%) had unilateral traumatic cataracts. An intraocular lens was implanted in 93% of eyes. Visual acuities at last follow-up: bilateral cases in the better eye: good (≥6/18 or fix and follow) in 21/34 eyes (62%), borderline (<6/18-6/60) in 4 eyes (12%) and poor (<6/60) in 9 eyes (26%). In unilateral non-traumatic cases: good in 6 eyes (33%), borderline in 3 eyes (17%) and poor in 9 eyes (50%). In unilateral traumatic cases: good in 36 eyes (40%), borderline in 20 eyes (23%) and poor in 33 eyes (37%). In bilateral cataract, worse outcomes were associated with preoperative nystagmus/strabismus. In traumatic cases, worse outcomes were associated with the preoperative trauma-related complications. CONCLUSIONS Visual acuity improved significantly after surgery, with better outcomes in bilateral cases. Early detection and surgery by a trained surgeon with good follow-up and postoperative rehabilitation can lead to better visual outcomes.
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Affiliation(s)
- Mulusew Asferaw
- Department of Ophthalmology, University of Gondar, Gondar, Ethiopia
| | | | | | - Clare E Gilbert
- Clinical Research Department, International Centre for Eye Health, London School of Hygiene and Tropical Medicine, London, UK
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du Toit R, Courtright P, Lewallen S. The Use of Key Informant Method for Identifying Children with Blindness and Severe Visual Impairment in Developing Countries. Ophthalmic Epidemiol 2017; 24:153-167. [PMID: 28287870 DOI: 10.1080/09286586.2016.1259637] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
PURPOSE An estimated 19 million children are visually impaired; of these, 1.4 million are irreversibly blind. A key challenge is to identify them early in life to benefit maximally from visual rehabilitation, and/or treatment. This aggregative review and structured literature analysis summarizes evidence of what it is about the key informant (KI) approach that works to identify children with blindness or severe visual impairment (B/SVI) in the community (for whom, to what extent, in what circumstances, in what respect, how and why). METHODS Peer-reviewed (PubMed, hand search) and grey literature (Google, World Health Organization website, academic theses, direct requests) were included, and methods and criteria used for identification, productivity (number of children referred per KI), accuracy of referrals (positive predictive value, PPV), age of children with B/SVI, KI definition, sex, information about cost and comparisons aggregated. RESULTS We included 31 documents describing 22 unique KI programs. Mostly KIs identified children with B/SVI in 1-3 weeks, i.e. "campaign mode." In 60%, KIs were community volunteers, others formal health sector workers (FHSW). Around 0.02-1.56 children per KI (median = 0.25) were successfully recruited. PPV ranged from 12 to 66%. In two studies comparing FHSWs and community KIs, the latter were 8 and 10 times more productive. CONCLUSION KIs working in campaign mode may provide an effective approach to identifying children with B/SVI in communities. Including identification of ocular problems and/or other impairments has been recommended. Research on factors that influence effectiveness and on whether KIs continue to contribute could inform programs.
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Affiliation(s)
| | - Paul Courtright
- b Kilimanjaro Centre for Community Ophthalmology , UCT Division of Ophthalmology, Groote Schuur Hospital , Cape Town , South Africa
| | - Susan Lewallen
- b Kilimanjaro Centre for Community Ophthalmology , UCT Division of Ophthalmology, Groote Schuur Hospital , Cape Town , South Africa
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Duke RE, Adio A, Oparah SK, Odey F, Eyo OA. Evaluation of a Public Child Eye Health Tertiary Facility for Pediatric Cataract in Southern Nigeria I: Visual Acuity Outcome. Open Ophthalmol J 2016; 10:119-25. [PMID: 27347247 PMCID: PMC4899512 DOI: 10.2174/1874364101610010119] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2015] [Revised: 01/14/2016] [Accepted: 01/16/2016] [Indexed: 11/22/2022] Open
Abstract
Purpose: A retrospective study of the outcome of congenital and developmental cataract surgery was conducted in a public child eye health tertiary facility in children <16 years of age in Southern Nigeria, as part of an evaluation. Materials and Method: Manual Small Incision Cataract Surgery with or without anterior vitrectomy was performed. The outcome measures were visual acuity (VA) and change (gain) in visual acuity. The age of the child at onset, duration of delay in presentation, ocular co-morbidity, non ocular co-morbidity, gender, and pre operative visual acuity were matched with postoperative visual acuity. A total of 66 children were studied for a period of six weeks following surgery. Results: Forty eight (72.7%) children had bilateral congenital cataracts and 18 (27.3%) children had bilateral developmental cataracts. There were 38(57.6%) males and 28 (42.4%) females in the study. Thirty Five (53%) children had good visual outcome (normal vision range 6/6/ -6/18) post-operatively. The number of children with blindness (vision <3/60) decreased from 61 (92.4%) pre-operatively to 4 (6.1%) post-operatively. Post operative complication occurred in 6.8% of cases six week after surgery. Delayed presentation had an inverse relationship with change (gain) in visual acuity (r = - 0.342; p-value = 0.005). Pre-operative visual acuity had a positive relationship with post operative change (gain) in visual acuity (r = 0.618; p-value = 0.000). Conclusion: Predictors of change in visual acuity in our study were; delayed presentation and pre-operative VA. Cataract surgery in children showed clinical benefit.
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Affiliation(s)
- Roseline E Duke
- Department of Ophthalmology, University of Calabar Teaching Hospital, Calabar, Cross River State, Nigeria
| | - Adedayo Adio
- Department of Ophthalmology, University of Port Harcourt Teaching Hospital, Port Harcourt, Nigeria
| | - Sidney K Oparah
- Department of Medicine, University of Calabar Teaching Hospital, Calabar, Cross River State, Nigeria
| | - Friday Odey
- Department of Pediatrics, University of Calabar Teaching Hospital, Calabar, Cross River State, Nigeria
| | - Okon A Eyo
- Department of Community Medicine, University of Calabar Teaching Hospital, Calabar, Cross River State, Nigeria
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10-Year Overview of the Hospital-Based Prevalence and Treatment of Congenital Cataracts: The CCPMOH Experience. PLoS One 2015; 10:e0142298. [PMID: 26540510 PMCID: PMC4634994 DOI: 10.1371/journal.pone.0142298] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2015] [Accepted: 10/20/2015] [Indexed: 12/31/2022] Open
Abstract
A review of 6 years of hospitalization charts from Zhongshan Ophthalmic Center (ZOC) revealed that congenital cataracts (CC) accounted for 2.39% of all cataract in-patient cases and that the age at surgery was decreasing before the establishment of the Childhood Cataract Program of the Chinese Ministry of Health (CCPMOH) in December 2010. We aimed to investigate data from the 4 years (January 2011 to December 2014) following the establishment of the CCPMOH, compared, and combined with data from the previous study period (January 2005 to December 2010) to generate a 10-year overview of the hospital-based prevalence and treatment of CC. In the 4-year period after CCPMOH establishment, the prevalence of CC was 2.01% in all hospitalizations, and was 2.78% in all cataract in-patients. Most of the eligible CC in-patients (71%) lived in south China. The ratio of boys to girls was 1.42:1. Nearly 2/3 of the patients underwent cataract extraction with primary intraocular lens (IOL) implantation at a mean age of 78.40±51.45 months, and cataract extraction surgeries without IOL implantation were performed in the remaining 1/3 of patients at a mean age of 10.03±15.92 months. After CCPMOH establishment, an increased incidence of CC was revealed, and the CC in-patients were younger than the patients in the previous period. The 10-year overview (2421 CC in-patients from 206630 hospitalizations) revealed upward trends in both the number and the prevalence of CC and a further reduction in age at surgery. In conclusion, the data from 4-year period after CCPMOH establishment and the 10-year overview showed upward trends in the hospital-based prevalence of CC cases and a further reduction in age at surgery, likely reflecting the effects of the CCPMOH establishment and providing useful information for further CC studies and a valuable foundation for the prevention and treatment of this cause of childhood blindness.
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