Results of cataract surgery in young children in east Africa

Background-Cataract is the leading cause of blindness in children in east A frica. The results of surgery are poor, partly because of inadequate correc tion of aphakia. Methods-A retrospective survey of 118 eyes in 71 children with bilateral ca taract. All eyes had implantation of an IOL at the time of cataract surgery . The average age at surgery was 3.5 years. 28 patients(39%) were less than 2 years old at the time of surgery on their first eye. Results-Preoperatively, 75.4% of eyes and 76.1% of patients were blind. A f ollow up of at least 3 months was available in 91 (77.1%) eyes. In these ey es, 44% had a latest corrected vision of 6/18 or better and 91.2% had a lat est corrected vision of 6/60 or better. Eyes with zonular cataract, and eye s operated after the age of 2 years were more likely to obtain a vision of 6/18 or better. 3.3% of eyes and 1.8% of patients had an acuity of less tha n 3/60. Nystagmus was present in 42.3% of patients before surgery. In those patients followed up for a minimum of 6 months, 10.2% still had nystagmus. The most frequent complication was severe fibrinous uveitis, which occurre d in 36 (30.5%) eyes. 62 (52.5%) eyes had a posterior capsulotomy at the ti me of cataract extraction. Of the remaining 56 eyes, 20 (35.7%) had so far required a posterior capsulotomy. The leading cause of poor visual outcome was amblyopia. Two patients developed severe complications related to the i ntraocular lens. Conclusions-Insertion of a lens implant at the time of cataract extraction appears to be well tolerated in the short term, and may offer significant a dvantages in an African setting.