Review of childhood cataract surgery at Kikuyu eye unit
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Date
2007-06Author
Monze, Namani H
Type
ThesisLanguage
enMetadata
Show full item recordAbstract
Objective: To establish the long term outcome of cataract surgery in children
below 15 years performed between 1996and 2005at Kikuyu Eye Unit.
Methods: This was a retrospective study. We reviewed records of children who
under went cataract surgery from January 1996to December 2005at KEU.
Results: Nine hundred and fifty three (953) files of patients with childhood
cataract (1,514 eyes) were reviewed. 39.3% were female and 60.7%were male.
The age range was 2 months to 15 years and the mean 7.4 years. 58.9% had
bilateral cataracts while 41.1%were unilateral. The commonest type of cataract
operated was congenital cataract. 18.0% of the operated cataracts had past eye
disease. 90.7%of those who had past eye disease were due to trauma. 5.9%had
other systemic findings of which 21.4% of these were due to congenital rubella
syndrome. Pre-operative vision ranged from 6/12 to NPL. 25.2%did not have
their vision indicated. 5.6%of the eyes had anterior segment findings and these
were due to past trauma. 25% of the eyes had posterior segment findings.
The commonest surgical technique used was lensectomy + AV + IOL which
accounted for 61.2%. Aphakia was mainly corrected with IOL + spectacles
(71.7%).Complications were noted in 788 eyes (52%) operated and included
Fibrinoid reaction in 466 eyes (59.2%),PCO in 120 eyes (15.4%)and amblyopia in
36 eyes (4.6%). Other complications were extremely rare. Follow-up was very
poor. However, from the few that came for follow-up refractive change (myopic
shift) with time was noted in both congenital and traumatic cataract. In both
congenital and traumatic cataract vision improved with time. Visual acuity
improvement at 6 months was seen to be better in traumatic cataracts than in
congenital cataract. Eyes with pre-existing strabismus also showed improvement
in visual acuity as well as those with pre-existing nystagmus.
The least improvement was seen in eyes with pre-existing microphthalmos.
Conclusions: Though it was not possible to accurately determine long term
outcome of childhood cataract surgery because of poor follow-up the following
observations were made;
visual outcome improved with time post-operative in both congenital and
traumatic cataract
there was myopic shift observed with time in both congenital and traumatic
cataract at six months.
Children with pre existing nystagmus and strabismus had better visual
outcome compared to those with pre existing microphthalmos at six months.
Recommendations: In view of the above conclusions the following is
recommended;
1. Address barriers to follow-up of children after cataract surgery
2. All children coming with associated ocul•ar finding such as nystagmus and
strabismus should be operated on.
3. Whenever you implant an IOL in a child bear in mind that myopic shift
will occur.
Citation
Master of Medicine (ophthalmology), University of Nairobi, 2007Publisher
University of Nairobi, Department of Ophthalmology