title: Outcomes of bilateral cataract surgery in Tanzanian children.
abstract: OBJECTIVE
  To investigate outcomes of bilateral pediatric cataract surgery in east Africa.
  
  
  METHODS
  Retrospective interventional case series.
  
  
  METHODS
  Two hundred forty-three children who underwent bilateral cataract surgery at the Comprehensive Community-Based Rehabilitation for Tanzania Disability Hospital between 2001 and 2004.
  
  
  METHODS
  Demographic, surgical, preoperative, and postoperative clinical characteristics obtained from patient records were entered into a database (Microsoft Excel; Microsoft, Redmond, WA), and statistical analysis was conducted using SPSS software for Windows (SPSS, Inc., Chicago, IL).
  
  
  METHODS
  Postoperative visual acuities and factors affecting them and postoperative refraction results.
  
  
  RESULTS
  Intraocular lenses were inserted in the first eyes of 232 children (149 Alcon AcrySof [Alcon Laboratories, Fort Worth, TX], 83 polymethyl methacrylate [PMMA]). Fifty-eight (62%) of 94 patients with final follow-up acuities recorded in both eyes achieved 20/60 or better in their better eye and 13 (13%) of 94 patients were blind. Of the various predictors of good visual outcome identified for children or eyes, only absence of preoperative blindness (odds ratio [OR], 7.3; 95% confidence interval [CI], 3.0-18.0; P<0.0005) remained significant in a multivariate logistic regression model. One hundred nine (51%) of 212 refracted first eyes had early postoperative refractive error spherical equivalent magnitudes of 2 diopters (D) or more. Ninety-nine (47%) of 212 eyes had initial postoperative cylinders of 3 D or more, dropping to 30 (18%) of 164 of those who had later follow-up refraction. Presence of biometric data was not associated with smaller postoperative refractive errors. Eyes with AcrySof lenses were less likely (OR, 2.5; 95% CI, 1.04-6.06) to have more than 3 D of astigmatism at latest follow-up. AcrySof lenses also were more likely (OR, 2.1; 95% CI, 1.2-3.7) to be fixated in the bag than PMMA lenses. Acute fibrinous uveitis occurred in 30 cases (12%), and transient corneal haze occurred in 20 cases (8%). Twenty-seven (11%) had chronic complications, 69 (28%) underwent a further general anesthetic procedure, and 9 (4%) underwent yytrium-aluminum-garnet capsulotomy.
  
  
  CONCLUSIONS
  Preoperative blindness was the strongest predictor of poor postoperative visual outcome; the use of AcrySof lenses as opposed to PMMA lenses made in-the-bag fixation more likely and also reduced postoperative astigmatism.
authors: Comprehensive Community-Based Rehabilitation for Tanzania Disability Hospital, Dar es Salaam, Tanzania.
authors: Richard J C
authors: RJ
authors: Bowman
authors: Joy
authors: J
authors: Kabiru
authors: Guy
authors: G
authors: Negretti
authors: Mark L
authors: ML
authors: Wood
mesh_terms: D000179:Acrylates; D000293:Adolescent; D001251:Astigmatism / Q000503:physiopathology; D002386:Cataract / Q000453:epidemiology / Q000503:physiopathology; D002387:Cataract Extraction; D002648:Child; D002675:Child, Preschool; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007223:Infant; D019654:Lens Implantation, Intraocular; D008297:Male; D017063:Outcome Assessment, Health Care; D019904:Polymethyl Methacrylate; D011183:Postoperative Complications; D012189:Retrospective Studies; D013636:Tanzania / Q000453:epidemiology; D014792:Visual Acuity / Q000502:physiology*
chemical_list: D000179:Acrylates; D019904:Polymethyl Methacrylate