Outcomes of paediatric cataract surgery at Lighthouse for Christ Eye Centre - Mombasa, Kenya: A retrospective case series

Abstract

Background: Paediatric cataract is one of the main and treatable causes of childhood blindness and visual impairment in developing countries, with varied outcome because of lack of properly equipped facilities, late presentation and poor follow-up.
Objective: This study aimed to assess the outcome of non-traumatic cases of paediatric cataract surgically managed at Lighthouse for Christ Eye Centre, Mombasa, Kenya.
Methods: This was a retrospective case series carried out from 1st January 2013 to 31st December 2014. Eyes of children<16 years of age operated for non-traumatic cataract, were included. The clarity of the visual axis and the Visual Acuity (VA) were the primary outcome measures. The types of surgery, the method of aphakic correction and complication rates were also recorded.
Results: Most patients were males (male: female ratio of 2.5:1). Majority of patients were in the 1-5 year age category (48.7%). Most patients were bilaterally affected (70.5%), with developmental cataract being the most common in 67.7% of eyes. Majority of the surgeries done were lensectomy + anterior vitrectomy (AV) + intraocular lens (IOL) implantation. Foldable IOLs were the most commonly implanted, in 82 eyes (75.2%). Twenty-four eyes were left aphakic (18%). The most common type of post-operative refractive correction was spectacles (55.6%). Majority of eyes with post-operative VA recorded, fell in the good outcome category as per World Health Organization (WHO) and Kilimanjaro Centre for Community Ophthalmology (KCCO) guidelines, for each follow-up visit. More than 90% of eyes had a clear visual axis for each follow-up period. At 12 weeks follow-up period, post-operative findings and complications were noted in approximately 40% of eyes, the most common finding was amblyopia (8.8 %).
Conclusion: Lens washout, primary posterior capsulotomy, anterior vitrectomy and primary intra-ocular lens implantation offers an effective method for correction of aphakia related to paediatric cataract surgery. It also maintained a clear visual axis for up to 1 year post-operatively with a significant number (>90%) remaining clear at each follow up visit. A majority of eyes (50%) had good visual outcome.
Recommendations: Strict follow up schedule is advised for consistent visual rehabilitation to further
improve the outcome.