Pediatric cataract surgery in Madagascar

Abstract

Background: Cataract is the main cause of blindness among children in Africa, having replaced vitamin A deficiency and measles. The management of childhood cataract in Africa, especially francophone countries, is inadequate.

Aims and objective: The objective is to study the age at presentation of children diagnosed with cataract, their visual outcomes, and follow-up patterns after surgery in Madagascar.

Materials and methods: This was a retrospective case series of children operated on for cataract in one of the busiest eye hospitals in Madagascar between September 1999 and July 2009. Data were obtained from theater logs and patient case notes and entered in a Microsoft Excel spreadsheet. Data entry was carried out using Microsoft Excel and analysis using Intercooled Stata version 9.0. Student t-test and Pearson's Chi-square were used to test associations where appropriate.

Results: A total of 60.5 percent of the 86 children operated on during the study period were boys. The mean age at presentation was 6.9 years (±SD 4.3) for congenital cataract, 13.1 years (±SD 2.9) for developmental cataract and 9.4 years (±SD 4.0) for traumatic cataract. A total of 36 children (41.9%) came back for follow-up, while 72 children (83.7%) were lost to follow-up 5 weeks after surgery. The mean follow-up period was 5 weeks (±SD 17.9). Children, who were brought back for follow-up were younger than those who were not. Although 64 (74.4%) of children had refraction during their encounters with the eye care facility, only 3 (3.5%) were provided with glasses. At last documented follow-up, 2.7% of the children had 6/18 vision or better.

Conclusions: In Madagascar, presentation for congenital and developmental cataract is very late, visual outcome poor and follow-up inadequate. There is an urgent need for a childhood blindness program to effectively deal with pediatric cataract, an avoidable cause of blindness and visual disability in children on the island nation.