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Meta-Analysis
. 2024 Dec 9;19(12):e0315263.
doi: 10.1371/journal.pone.0315263. eCollection 2024.

Through the fog: Systematic review and meta-analysis of the prevalence and associated factors of poor post-operative visual outcome of cataract surgery in Sub-Saharan Africa

Zufan Alamrie Asmare  1 , Beminate Lemma Seifu  2 , Bezawit Melak Fente  3 , Yohannes Mekuria Negussie  4 , Hiwot Altaye Asebe  2 , Meklit Melaku Bezie  5 , Mamaru Melkam  6 , Angwach Abrham Asnake  7
Affiliations
Meta-Analysis

Through the fog: Systematic review and meta-analysis of the prevalence and associated factors of poor post-operative visual outcome of cataract surgery in Sub-Saharan Africa

Zufan Alamrie Asmare et al. PLoS One. .

Abstract

Background: Cataract, despite being treatable, persists to have a devastating impact on people's health and livelihoods all over the world. In Sub-Saharan Africa (SSA), 1.7 million people are blind and 6.94 million are visually impaired due to cataract. Also, Cataract surgery outcomes remain below the World Health Organization (WHO) recommendations in SSA. Hence, this review aimed to estimate the pooled prevalence and associated factors of poor post-operative visual outcome in SSA.

Method: An intensive literature search was performed from PubMed, Google Scholar, EMBASE, HINARI, Scopus, and Web of Sciences. Data were extracted by using a pre-tested and standardized data extraction format and analyzed by using STATA 17 statistical software. I2 tests to appraise the heterogeneity across the included studies, a random-effect model to estimate the pooled prevalence, and a sub-group analysis to discern the viable source of heterogeneity were executed. Potential publication bias was also assessed by funnel plot, Egger's weighted correlation, and Begg's regression. The odds ratio with its 95% confidence was used to reckon the association between the prevalence and factors.

Result: From 201 identified studies, 25 articles were included. The pooled prevalence of poor post-operative visual outcome of cataract surgery in SSA was 14.56% (95% CI 11.31, 17.81). The presence of intra-operative complications (AOR = 2.99, 95% CI: 1.79, 4.98) and the presence of post-operative complications (AOR = 3.56, 95% CI: 2.86, 4.43) were statistically significant with the pooled poor post-operative visual outcome. According to the subgroup analysis, the pooled prevalence of poor post-operative visual outcome was found lower in phacoemulsification, with a sub-pooled prevalence of 12.32% (95% CI 7.89, 16.74) compared to incisional with a sub-pooled prevalence of 16.28% (95% CI 10.98, 21.59).

Conclusion: This meta-analysis revealed that a substantial proportion of cataract-operated patients had poor post-operative visual outcome. The presence of intra-operative complications and post-operative complications were independent predictors of poor post-operative visual outcome. Therefore, improvement of post-operative visual outcome through decreasing intra-operative complications, managing post-operative complications, and investing in specialized training and equipment for ophthalmic surgeons are pivotal and need significant emphasis.

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Conflict of interest statement

The authors have declared that no competing interests exist.

Figures

Fig 1
Fig 1. Flow chart diagram describing the selection of studies for the systematic review and meta-analysis of the poor post-operative visual outcome of cataract surgery and associated factors in Sub-Saharan Africa.
Fig 2
Fig 2. Forest plot of the pooled prevalence of poor post-operative visual outcome of cataract surgery in Sub-Saharan Africa.
Fig 3
Fig 3. Forest plot of the pooled prevalence of poor post-operative visual outcome of cataract surgery in Sub-Saharan Africa by the type of cataract surgery.
Fig 4
Fig 4. Forest plot of the pooled prevalence of poor post-operative visual outcome of cataract surgery in Sub-Saharan Africa by economic level of countries.
Fig 5
Fig 5. Funnel plot of the studies included in a systematic review and meta-analysis of the pooled magnitude of poor post-operative visual outcome of cataract surgery in sub-Saharan Africa.
Fig 6
Fig 6. Egger’s test of the studies included in a systematic review and meta-analysis of the pooled magnitude of poor post-operative visual outcome of cataract surgery in sub-Saharan Africa.
Fig 7
Fig 7. Forest plot showing pooled odds ratio (log scale) of the association between of age of participants and poor post-operative visual outcome.
Fig 8
Fig 8. Forest plot showing pooled odds ratio (log scale) of the association between the presence of pre-operative astigmatism and poor post-operative visual outcome.
Fig 9
Fig 9. Forest plot showing pooled odds ratio (log scale) of the association between the presence of intra-operative complication and poor post-operative visual outcome.
Fig 10
Fig 10. Forest plot showing pooled odds ratio (log scale) of the association between postoperative complication and poor post-operative visual outcome.
See this image and copyright information in PMC

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