The University Of Nairobi Audit Of Visual Outcome Of Cataract Surgery In Garissa General Hospital

Abstract

STUDY BACKGROUND: Cataract is the opacification of the natural lens that focusses light on to the retina. It is the leading cause of blindness world-wide. Cataract blindness is reversible by surgery that involves extraction of the opacified lens. Although high volumes of surgeries are being performed in developing areas, there are concerns about the quality of outcome. (1) WHO recommend that 80% or more of operated eyes must have good outcome (≥6/18vision) (1). However according to Lancet global health commission on global eye health WHO recommends an update to the benchmark threshold of effectiveness for a good outcome, which should be a presenting visual acuity of 6/12 or better (2). Regular surgical audit will help to achieve the WHO recommendation. STUDY OBJECTIVE: To assess the visual outcome of age related cataract surgery in Garissa county general hospital for the year 2021 STUDY DESIGN: A hospital based retrospective study. STUDY SITE: Garissa general Hospital in Garissa Township, which is located 370km from Nairobi and is the regional headquarters for North Eastern Kenya. STUDY POPULATION: Patients who underwent age related cataract surgery at Garissa general hospital in the year 2021 METHODOLOGY: The data was collected using a questionnaire to document patient characteristics, preand post-surgery examination findings, surgery details and complications. Descriptive and analytical statistics was applied to analyse the data RESULTS All of 144 eyes underwent cataract surgery were blind (VA of <3/60) before surgery. At week one, 3.5% of the patients had good outcome, 59.1% borderline and 37.3% poor outcome. At week four good outcome was 10.6% and 33.6% with poor outcome. Biometry was done on 60.4% of the eyes while 39.6% had no biometry done. Posterior capsule tear was the main intra-operative complication accounted for 2% of the patients, but among the patients had PC tear, only 0.7 % had vitreous loss. The main cause of poor outcome was found to be refractive error (39%) followed by comorbidity (34.1%) and glaucoma was most significant comorbidity (20.8%). CONCLUSION Good visual acuity outcome at week four was below WHO recommendation due to refractive error and comorbidity.