Determinants of pediatric cataract program outcomes and follow-up in a large series in Mexico.
OBJECTIVE
To report determinants of outcomes and follow-up in a large Mexican pediatric cataract project.


METHODS
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.
Congdon
Nathan G
NG
Department of Ophthalmology and Visual Science, Chinese University of Hong Kong, Kowloon, Hong Kong, People's Republic of China. ncongdon@cuhk.edu.hk
Ruiz
Sergio
S
Suzuki
Maki
M
Herrera
Veronica
V
D000293:Adolescent; D000550:Amblyopia / Q000453:epidemiology; D002386:Cataract / Q000145:classification / Q000150:complications*; D002387:Cataract Extraction / Q000706:statistics & numerical data*; D002648:Child; D002675:Child, Preschool; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007223:Infant; D007431:Intraoperative Complications; D019654:Lens Implantation, Intraocular / Q000706:statistics & numerical data*; D008297:Male; D008800:Mexico / Q000453:epidemiology; D009759:Nystagmus, Pathologic / Q000453:epidemiology; D011183:Postoperative Complications; D015397:Program Evaluation; D011446:Prospective Studies; D012029:Refraction, Ocular / Q000502:physiology; D016896:Treatment Outcome; D014786:Vision Disorders / Q000209:etiology / Q000534:rehabilitation*; D014792:Visual Acuity / Q000502:physiology; D014821:Vitrectomy / Q000706:statistics & numerical data