Long-term outcomes of pediatric cataract surgery evaluated in Indian study

A joint effort by Orbis and a hospital in Miraj, India, examined 262 children operated on between 2005 and 2008.

Issue: May 2012

ABU DHABI — The long-term outcome of pediatric cataract surgery at Lions NAB Eye Hospital in Miraj, India, was evaluated as part of the broader India Childhood Blindness Initiative of Orbis International.

“There are very few reports of the outcomes of pediatric cataract surgery from India and Nepal, and most focus on short-term outcome, between 6 weeks and 3 months of follow-up,” Parikshit Gogate, MD, principal investigator, said at the World Ophthalmology Congress.

With pediatric cataract surgery, however, a long-term follow-up is mandatory because as the child grows, the eye develops and might need further adjustments to maintain or restore vision.

Study design

The study re-examined the case records of 520 cataracts in 374 children operated on between 2005 and 2008. The children were identified and grouped according to talukas, or sub-districts, and villages.

“Mapping allowed us to have a clear idea of how to organize and optimize our time and efforts,” Dr. Gogate said. “We found the children and transported them by vehicle to the LNEH with their parents for examination. Seventy-four did not come to LNEH but were scheduled for home visits with all the required equipment.”

The children or parents were given a questionnaire about visual function. A complete ocular examination was performed, data were recorded, and treatment was given if required.

Of the 374 children, 328 (88%) were identified and 262 (77%) completed the questionnaire and were examined. All but 19 required some form of intervention, such as YAG capsulotomy (103 children) or surgery (22 children). Most needed a change of spectacles, five needed contact lenses, and four required low-vision aids.

The research team included Dr. Shailbala Patil, Prof. Anil Kulkarni, Dr. Ashok Mahadik, Dr. Mitali Shah and Dr. Mohini Sahasrabudhe.

Worthwhile investment

Most children were operated on between the ages of 6 and 10 years. The time between surgery and final assessment ranged from 3 to 8 years. The age at the time of the study examination ranged from 3 to 22 years.

Of 129 children operated on bilaterally and followed up for 3 years to 7 years, 43% achieved 20/63 or better visual acuity and 61% achieved 20/200 or better.

“Congenital cataract performed poorly, with only 37% achieving 20/63 vision. We also had more than 100 cases of cataracts of indeterminate etiology, of which only 38% achieved 20/63. Older children did better, probably because their visual system had already developed at the time of surgery. Phaco led to better results than manual small incision. Children who had a regular follow-up definitely did better,” Dr. Gogate said.

The study confirmed that visual results of cataract surgery in children are suboptimal compared with results of cataract surgery in adults. This happens more often in developing countries, as shown by the literature, but can also occur in developed countries. The cost of cataract surgery in children, however, is almost 10 times more than in adults.

“Though we are well aware that we cannot expect particularly good results in terms of visual acuity, the investment is highly worthwhile. Vision function questionnaires show that operated children have significantly better ability to perform tasks like identifying coins, threading needles, lacing shoes, climbing stairs, reading and writing,” Dr. Gogate said.

There is a need for a better outreach strategy, he said. Affordability and accessibility issues have to be addressed.

“We also need to increase awareness levels and motivate parents about the importance of timely examination, treatment and follow-up,” Dr. Gogate said. “Cataract surgery in children is not a 100-meter dash but rather a marathon, with monitoring extending over years.” – by Michela Cimberle

For more information:

Parikshit Gogate, MD, can be reached at Dr. Gogate’s Eye Clinic, K-102, Kumar Garima, Tadiwala Road, Pune 411 001, Maharashtra, India; email: parikshitgogate@hotmail.com.

Disclosure: Dr. Gogate has no relevant financial disclosures.