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Does prospective monitoring improve cataract surgery outcomes in Africa?

¹ Department of Epidemiology and International Eye Health, Institute of Ophthalmology, Bath Street, London EC1V 9EL, UK
² Kikuyu Eye Unit, Kikuyu, Kenya
³ CCBRT Eye Hospital, Dar-es-Salaam, Tanzania
⁴ London School of Hygiene and Tropical Medicine, Keppel Street, London WC1E7HT, UK

Correspondence to:
Correspondence to:
Dr David Yorston, Department of Epidemiology and International Eye Health, Institute of Ophthalmology, Bath Street, London EC1V 9EL, UK;
dhyorston{at}enterprise.net

Aims: To determine if prospective monitoring influences cataract surgical outcomes in east Africa.

Methods: A prospective observational study of all routine extracapsular cataract extractions with posterior chamber lens implants carried out at Kikuyu Eye Unit, Kenya, between 1 January 1999 and 31 December 1999.

Results: Out of 1845 eligible eyes 1800 were included in the study. Two months' follow up was available in 67.2% of patients. The proportion achieving a good outcome increased steadily from 77.1% in the first quarter to 89.4% in the fourth quarter (² for trend, p<0.001). There was no change in the incidence of operative complications; however, the proportion of patients achieving a good visual outcome following vitreous loss increased from 47.2% in the first 6 months to 71.0% in the last 6 months (² p<0.05). Of the eyes with poor outcome (best corrected acuity <6/60 at 2 months) half were due to pre-existing eye diseases. The proportion of patients with known ocular comorbidity decreased from 10.2% in the first quarter to 5.9% in the fourth quarter (² for trend, p<0.05). Poor outcome was associated with age over 80 years, known diabetes, preoperative bilateral blindness, any ocular comorbidity, and intraoperative vitreous loss.

Conclusions: This study demonstrates improvement in visual outcome results after cataract surgery over a 1 year period. Monitoring of outcomes appears to be associated with a change in surgeons' attitudes, leading to greater emphasis on appropriate case selection, better management of surgical complications, and improved visual outcomes.

Keywords: cataract surgery; Africa; monitoring

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