Bilateral pediatric cataract surgery: outcomes of 390 children from Nepal and Northern India.

PURPOSE: To report the outcomes of bilateral pediatric cataract surgery from eastern Nepal and northern India. METHODS: Preoperative, intraoperative, and postoperative data of 390 children who underwent surgery bilaterally between 2007 and 2009 were analyzed. RESULTS: Forty-two (10.8%) children came from Nepal and 348 (89.2%) from India (mainly Bihar State). Intraocular lens (IOL) implantation with posterior capsule opening and anterior vitrectomy were achieved in 386 (99.0%) children bilaterally. Median age at surgery was 7 years and 69.2% were male. At first presentation, 243 (62.3%) of the children were blind (< 3/60 in the better eye). After more than 1 year, 53.5% had a normal visual status (range: 6/6 to 6/18), 5.6% of children were still blind, and mean refractive error spherical equivalent was +1.0 ± 2.4 diopters. Astigmatism changed from suture-induced with the rule at discharge to against the rule within 3 weeks of surgery. Mean long-term astigmatic error was 1.0 ± 0.9 diopters after 1 year. Glaucoma was rare. CONCLUSIONS: Even in a setting with limited resources, successful, cost-effective, high-volume surgery for pediatric cataract is possible. Despite late presentation and limited follow-up, more than half achieved good outcomes after more than 1 year. Only 5.6% remained blind due to amblyopia or eye anomalies. Bilateral surgery during one hospital stay, IOL implantation with undercorrection according to age, aggressive surgery to prevent secondary cataract, intensive anti-inflammatory therapy, and provision of durable, high-quality spectacles to take home all proved beneficial because many children cannot attend for regular follow-up.

Restoration of severely impaired eyesight in an adolescent with down syndrome and bilateral cataract in South Asia.

PURPOSE: To report the recovery of visual function after phacoemulsification in a 16-year-old adolescent with Down syndrome (DS) from Saharsa, India. METHODS: Interventional case report and short review of the pertinent literature. RESULTS: A 16-year-old South Asian male with DS and bilateral cataract underwent successful surgery in both eyes after considerable difficulty for his parents including cross-border travel from India into Nepal. After the operation, the patient responded to visual stimuli (e.g. movement of hands) that had eluded him prior to surgery, and thus the additional obstacle to social participation imposed by the impaired eyesight could be removed. CONCLUSIONS: The establishment of basic ophthalmological surgery in developing countries is feasible and can yield extraordinary benefits for individual patients.

Clinical characteristics and early postoperative outcomes of pediatric cataract surgery with IOL implantation from Lahan, Nepal.

PURPOSE: To report clinical characteristics and early postoperative outcomes of pediatric cataract surgery with intraocular lens (IOL) implantation from Lahan, Nepal. METHODS: Demographics and surgical, preoperative, and postoperative clinical characteristics data were collected and analyzed. RESULTS: Of 2,633 eyes with primary IOL implantation, 2,003 eyes were in the non-traumatic group, whereas 630 eyes were from trauma. Median age at surgery was 7 and 9 years in the non-traumatic and traumatic groups, respectively. Boys comprised 74.2% of the non-traumatic and 85.4% of the traumatic cataract patients. Unilateral cataracts accounted for only 7.7% (154 of 2,003) of the non-traumatic group. Average follow-up was 35 days with greater than 6 months follow-up in 134 of 2,633 (5.1%) eyes. Most (68.5% [1,804 of 2,633]) of the lens opacities were described as total cataract. Although early postoperative best-corrected visual acuity improved from the preoperative recording in 95.0% (2,495 of 2,626) of eyes, 78.1% (2,050 of 2,626) remained in the poor (20/100 or worse) category. Median preoperative and early postoperative best-corrected visual acuity was hand motions and 20/200, respectively. CONCLUSION: A high-volume cataract surgical center in Lahan, Nepal, is able to provide cost-effective and high-quality pediatric surgery. Most of the patients in this series were noted to have complete cataracts and were boys. Visual improvement was achieved, but excellent visual outcomes were rarely documented due to late referral and inadequate follow-up. Educating families and primary caregivers with regard to the importance of earlier referral and postoperative optical correction and tracking will improve outcomes.

Learning phacoemulsification. Results of different teaching methods.

We report the learning curves of three eye surgeons converting from sutureless extracapsular cataract extraction to phacoemulsification using different teaching methods. Posterior capsule rupture (PCR) as a per-operative complication and visual outcome of the first 100 operations were analysed. The PCR rate was 4% and 15% in supervised and unsupervised surgery respectively. Likewise, an uncorrected visual acuity of > or = 6/18 on the first postoperative day was seen in 62 (62%) of patients and in 22 (22%) in supervised and unsupervised surgery respectively.