Keywords
Paediatric cataract
Outcome
Categories
How to Cite
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.
References
Universal Eye Health: A Global Action Plan
–2019 was endorsed by the World Health
Assembly in May 2013.
Shirima S, Lewallen S, Kabona G. et al. Estimating
numbers of blind children for planning services:
findings in Kilimanjaro, Tanzania. Br J Ophthalmol.
; 93:1560-62.
Owens WC, Hughes WF. Results of surgical
treatment of congenital cataract. Arch Ophthalmol.
; 39:339-350.
Foster A, Gilbert C, Rahi J. Epidemiology of
cataract in childhood: a global perspective.
J Cataract Refract Surg. 1997; 23:601–604.
Tabin G, Chen M, Espandar L. Cataract surgery
for the developing world. Curr Opin Ophthalmol.
; 19:55‑59.
Eriksen J R, Bronsard A, Mosha M, et al.
Predictors of poor follow-up in children that had
cataract surgery. Ophthalmic Epidemiol. 2006;13:
–243.
Vishwanath M, Cheong-Leen R, Taylor D,
Russell-Eggitt IM, Rahi JS. Is early surgery for
congenital cataract a risk factor for glaucoma? Br J
Ophthalmol. 2004; 88:905–910.
Yorston D, Wood M, Foster A. Results of cataract
surgery in young children in East Africa. Br J
Ophthalmol. 2001; 85:267‑271.
Courtright P, Bowman R, Gilbert C, Lewallen
S, Van Dijk K, Yorston D. Childhood cataract in
Africa (KCCO childhood blindness manual) 2007.
Khandekar R, Sudhan A, Jain BK, Shrivastav K,
Sachan R. Pediatric cataract and surgery outcomes
in Central India: A hospital based study. Indian J
Med Sci. 2007; 17:25-33.
Thakur J, Reddy H, Wilson M, Pandya G,
Gurung R, Tabin G, Ruit S. Pediatric cataract
surgery in Nepal. J Cataract Refract Surg.
; 30:1629-1635.
Magnusson G, Abrahamson M, Sjostarnd J.
Changes in visual acuity from 4 to 12 years of
age in children operated for bilateral congenital
cataract. Br J Ophthalmol. 2002; 86:1385-1389.
Trivedi R, Wilson ME. Keratometry in pediatric
eyes with cataract. Arch Ophthalmol. 2008; 126
(1): 38-42.
Bowman RJC, Kabiru J, Negretti G, Wood ML.
Outcomes of bilateral cataract surgery in Tanzanian
children. Ophthalmology. 2007; 114:2287–92.
Wilson ME, Pandey SK, Thakur J. Pediatric
cataract blindness in the developing world: surgical
techniques and intraocular lenses in the new
millennium. Br J Ophthalmol. 2003; 87:14–19.
Vasavada A, Trivedi R, Nath V. Visual axis
opacification after acrys of intraocular lens
implantation in children. J Cataract Refract Surg.
; 30:1073-81.