Indian Journal of Ophthalmology (Jan 2012)
Causes, epidemiology, and long-term outcome of traumatic cataracts in children in rural India
- Parikshit Gogate,
- Mohini Sahasrabudhe,
- Mitali Shah,
- Shailbala Patil,
- Anil Kulkarni
Affiliations
- Parikshit Gogate
- Mohini Sahasrabudhe
- Mitali Shah
- Shailbala Patil
- Anil Kulkarni
- DOI
- https://doi.org/10.4103/0301-4738.100557
- Journal volume & issue
-
Vol. 60,
no. 5
pp. 481 – 486
Abstract
Purpose : To describe preoperative factors, long-term (>3 years) postoperative outcome and cost of traumatic cataracts in children in predominantly rural districts of western India. Subjects : Eighty-two traumatic cataracts in 81 children in a pediatric ophthalmology department of a tertiary eye-care center. Materials and Methods : Traumatic cataracts operated in 2004-2008 were reexamined prospectively in 2010-2011 using standardized technique. Cause and type of trauma, demographic factors, surgical intervention, complications, and visual acuity was recorded. Statistical Analysis : Data analysis done by using SPSS (Statistical package for social sciences) version 17.0 We have used Chi-square test, Fisher′s exact test, paired t-test to find the association between the final vision and various parameters at 5% level of significance; binary logistic regression was performed for visual outcome ≥6/18 and ≥6/60. Results : The children were examined in a 3-7 year follow-up (4.35 ± 1.54). Average age at time of surgery was 10.4 ± 4.43 years (1.03 to 18). Fifty (61.7%) were boys. Forty (48.8%) were blunt and 32 (39%) were sharp trauma. The most common cause was wooden stick 23 (28.0%) and sharp thorn 14 (17.1%). Delay between trauma and presentation to hospital ranged from same day to 12 years after the injury with median of 4 days. The mean preoperative visual acuity by decimal notation was 0.059 ± 0.073 and mean postoperative visual acuity was 0.483 ± 0.417 (P < 0.001). Thirty-eight (46.3%) had best corrected visual acuity (BCVA) ≥6/18 and 51 (62.2%) had BCVA ≥ 6/60. In univariable analysis, visual outcome (≥6/18) depended on type of surgery (P = 0.002), gender (P = 0.028), and type of injury (P = 0.07)-sharp trauma and open globe injury had poorer outcomes; but not on age of child, preoperative vision, and type of surgeon. On multivariable binary logistic regression, only gender was significant variable. Of the 82 eyes, 18 (22%) needed more than one surgery. The parents spent an average of Rs. 2250 ($45) for the surgery and 55 (66.4%) were from lower socio-economic class. Conclusion : The postoperative visual outcomes varied and less than half achieved ≥ 6/18.
Keywords
- Diabetes-related blindness
- diabetic retinopathy
- key informant
- rapid assessment of avoidable blindness
- retinopathy of prematurity
- tele-ophthalmology
- Blindness
- disability
- equity
- health economics
- health policy
- health and development
- social exclusion
- Community eye health
- prevention of blindness
- ophthalmogical residency
- VISION 2020
- Visual impairment
- blindness
- inequality
- social class
- income
- educational status
- gender and ethnic groups
- Advocacy
- effective service delivery
- enabling environment
- stakeholders
- resources
- Avoidable blindness and visual impairment
- impact
- scaling up
- VISION 2020
- Global blindness
- prevalence
- visual impairment
- visual acuity
- Comprehensive eye care
- eye care model
- pyramidal model
- Comprehensive eye care
- optometrist
- optometry regulation
- eye health
- India
- Economics
- blindness
- visual impairment
- market
- government
- cost
- Millennium development goals
- eye health
- Vision 2020 the Right to Sight
- Blindness
- eye care services
- planning rapid assessment methods
- visual impairment
- Avoidable blindness
- cataract surgical rate
- corneal blindness
- eye care services
- Compliance
- diabetic retinopathy
- services
- Human resource development
- service delivery
- social entrepreneurship
- uncorrected refractive error
- Blindness
- cataract extraction
- cataract
- coverage
- data aggregation
- population
- prevalence
- visual impairment
- Case detection
- comprehensive eye examination
- developing countries
- glaucoma
- integrated approach
- training requirements
- Child health policy
- childhood blindness
- social determinants of eye health
- Access
- Asia-pacific
- coverage
- funding
- low vision
- policy
- Funding
- vision research priorities
- peer review
- research
- Cataract surgery
- clinical outcome
- patient-reported outcome
- quality improvement
- quality
- Global eye health
- health interventions
- health systems
- systems thinking
- Avoidable blindness
- global cost
- health investment
- primary and secondary health
- visual impairment
- Trauma
- pediatric cataract
- visual outcome