Determinants of pediatric cataract program outcomes and follow-up in a large series in Mexico

• Published in: Journal of cataract and refractive surgery Vol. 33; no. 10; pp. 1775 - 1780
• Main Authors: Congdon, Nathan G., MD, MPH, Ruiz, Sergio, MD, Suzuki, Maki, MPA, Herrera, Veronica
• Format: Journal Article
• Language: English
• Published: New York, NY Elsevier Inc 01.10.2007; Elsevier Science
• Subjects: Adolescent; Amblyopia - epidemiology; Biological and medical sciences; Cataract - classification; Cataract - complications; Cataract Extraction - statistics & numerical data; Child; Child, Preschool; Female; Follow-Up Studies; Humans; Infant; Intraoperative Complications; Lens diseases; Lens Implantation, Intraocular - statistics & numerical data; Male; Medical sciences; Mexico - epidemiology; Nystagmus, Pathologic - epidemiology; Ophthalmology; Postoperative Complications; Program Evaluation; Prospective Studies; Refraction, Ocular - physiology; Surgery (general aspects). Transplantations, organ and tissue grafts. Graft diseases; Surgery of the eye and orbit; Treatment Outcome; Vision Disorders - etiology; Vision Disorders - rehabilitation; Visual Acuity - physiology; Vitrectomy - statistics & numerical data; Central America; Mexico; America; Human; Pediatrics; Cataract; Program; Prognosis; Determinant; Infant; Eye disease; Lens disease; Treatment; Surgery; Evolution; Ophthalmology; Child; Anterior segment disease
• ISSN: 0886-3350; 1873-4502
• DOI: 10.1016/j.jcrs.2007.06.025

Purpose To report determinants of outcomes and follow-up in a large Mexican pediatric cataract project. Setting Hospital Luis Sanchez Bulnes, Mexico City, Mexico. Methods Data were collected prospectively from a pediatric cataract surgery program at the Hospital Luis Sanchez Bulnes, implemented by Helen Keller International. Preoperative data included age, sex, baseline visual acuity, type of cataract, laterality, and presence of conditions such as amblyopia. Surgical data included vitrectomy, capsulotomy, complications, and use of intraocular lenses (IOLs). Postoperative data included final visual acuity, refraction, number of follow-up visits, and program support for follow-up. Results Of 574 eyes of 415 children (mean age 7.1 years ± 4.7 [SD]), IOLs were placed in 416 (87%). At least 1 follow-up was attended by 408 patients (98.3%) (mean total follow-up 3.5 ± 1.8 months); 40% of eyes achieved a final visual acuity of 6/18 or better. Children living farther from the hospital had fewer postoperative visits ( P = .04), while children receiving program support had more visits ( P = .001). Factors predictive of better acuity included receiving an IOL during surgery ( P = .04) and provision of postoperative spectacles ( P = .001). Predictive of worse acuity were amblyopia ( P = .003), postoperative complications ( P = .0001), unilateral surgery ( P = .0075), and female sex ( P = .045). Conclusions The results underscore the importance of surgical training in reducing complications, early intervention before amblyopia (observed in 40% of patients) can develop, and vigorous treatment if amblyopia is present. The positive impact of program support on follow-up is encouraging, although direct financial support may pose a problem for sustainability. More work is needed to understand reasons for worse outcomes in girls.