Bilateral paediatric cataract surgery - outcomes of 298 children from Kinshasa, the Democratic Republic of the Congo.

INTRODUCTION: The leading cause of childhood blindness globally is paediatric cataract. Bilateral cataract surgery can help to improve visual performance and to diminish the burden of childhood blindness. OBJECTIVE: To report in a retrospective observational cohort study the long-term outcomes of 298 children who had bilateral cataract surgery with IOL implantation from 2001-2016 in Kinshasa. METHODS: A standardized surgical treatment of paediatric cataract was practiced on 298 children. Patient's follow-up, complications, and visual outcomes were recorded and analysed. RESULTS: The mean age was 5.7 ± 4.3 years and males were predominant (64.9%). Most of children were living mainly in urban poorest areas (96.3%). Strabismus, nystagmus and microcornea were encountered in 20.1%, 25.1% and 8.7% of children, respectively. Using WHO criteria most of patients were classified as blind preoperatively and 81.9% of them had improved visual outcomes after surgery. Main reasons for reduced vision during follow-up were secondary cataract (5.7%), IOL decentration (1.2%), retinal detachment (1.2%), and secondary glaucoma (1.5%). CONCLUSION: In spite of the post conflict challenges, elimination of cataract blindness in children remains a priority. Children present at a late age for surgery and long term follow-up is poor. There is need for program strengthening in these areas.

Role of a Community-based Program for Identification and Referral of Pediatric Cataract Patients in Kinshasa, Democratic Republic of the Congo.

PURPOSE: The purpose of this study is to describe the methodology and to assess the effectiveness of a community-based rehabilitation (CBR) program to identify and refer children with blinding cataract for the management and surgery to reduce the burden of childhood blindness due to cataract in Kinshasa. METHODS: Church-based volunteers were trained to identify children with presumed eye disorders in their localities and households and to refer them for cataract identification by an ophthalmic nurse during parishes' visits. Volunteers were parishioners living in the quartiers where identification took place and worked as community workers with the CBR program. Nurses used a lamp-torch to rule out cataract. Selected children were referred to the tertiary eye health facility at St Joseph Hospital for diagnosis and management. RESULTS: Identification took place in 31 out of 165 parishes in the Archdioceses of Kinshasa from 2000 to 2016 and 11,106 children aged <16 years were screened. Among them, 1277 children (11.5%) were presumed to have cataract. Ninety-two children among them died before surgery; 107 children were lost to further follow-up and did not report to the CBR center for referral. Reasons given were change of home address, moving in their lieu of origin, death, and refusal of treatment by the parents. Finally, only 1078 children were referred to the pediatric ophthalmologist and 705 children (65.4%) were definitively diagnosed to have treatable cataract, while in 373 children (34.6%), cataract surgery was not indicated for several reasons. There was a positive history of familial cataract in 36 children (2.8%). CONCLUSION: Using church-based volunteers and ophthalmic nurses during community screening proved efficient in the identification and referral of pediatric cataract. Keeping regular identification activities in the community and maintaining high-quality and accessible pediatric cataract surgery services can help to clear up the backlog of cataract blind children.