Outcomes and Associated Factors of Cataract Surgery Among Adults Attending a Tertiary Hospital in Addis Ababa, Ethiopia

Abstract

Background

Visual outcomes and factors associated with cataract surgery vary from country to country and within countries. This study aimed to evaluate associated factors and visual outcomes following cataract surgery among adults attending Saint Paul’s Hospital Millennium Medical College (SPHMMC), Addis Ababa, Ethiopia.

Patients and Methods

We conducted a prospective, longitudinal study of consecutive adult patients scheduled for cataract surgery between May 2018 and April 2019. Preoperative, intraoperative and postoperative data were collected and analyzed using SPSS version 23.0. Descriptive statistics and binary logistic regressions were used to analyze the data. We used World Health Organization (WHO) criteria for cataract surgery outcome assessment as a reference for comparison.

Results

Three hundred fourteen eyes of 314 participants (mean age 64.16±8.83 SD, 52% females, 44% from rural location) were included in the study. Most, 283 (90.1%) had preoperative visual acuity less than 6/60. At final follow-up visit (6 to 8 weeks), best-corrected visual acuity (BCVA) was good (≥6/18) in 215 (68.5%), borderline (<6/18–6/60) in 63 (20.1%) and poor (<6/60) in 36 (11.5%) eyes. Age-related macular degeneration (AMD) [OR = 4.57, 95% CI [1.12–17.24], p=0.03] and preoperative astigmatism [OR = 3.22, 95% CI [1.25–8.33], p=0.01] were significantly associated with poor postoperative visual outcome.

Conclusion

While the majority of patients had good postoperative BCVA following cataract surgery, the percentage of patients with poor visual outcomes was higher than the WHO standard. Greater attention to pre-existing co-morbidities such as retinal disease and high astigmatism could improve outcomes by optimizing patient selection and surgical approach.

Keywords:

• cataract surgery
• Ethiopia
• factors
• outcome

Abbreviations

AC, Anterior chamber; AOR, Adjusted odds ratio; AMD, Age-related macular degeneration; BCVA, Best-corrected visual acuity; CCC, continuous curvilinear capsulorhexis; CI, Confidence interval; COR, Crude odds ratio; ECCE, extra-capsular cataract extraction; HIV/AIDS, Human immunodeficiency virus/Acquired immunodeficiency syndrome; IOL, Intraocular lens; IOP, Intraocular Pressure; K, keratometer; LP, Light perception; MSICS, Manual small incision cataract surgery; OVD, ophthalmic visco-surgical devices PBK, Pseudophakic bullous keratopathy; PC, Posterior chamber; PCO, Posterior capsular opacity; PMMA, Polymethyl methacrylate; RBA, Retro-bulbar anesthesia; SPHMMC, St. Paul’s Hospital Millennium Medical College; SPSS, Statistical package for social Sciences; STA, Sub-tenon anesthesia; UCVA, Uncorrected visual acuity; VA, Visual acuity; WHO, World Health Organization; YAG, Yttrium-aluminum-garnet.

Data Sharing Statement

The data is available from the corresponding author if requested in the form of statistical package for social sciences (SPSS).

Ethics Approval and Informed Consent

The study was approved by SPHMMC IRB directorate and informed written consent was taken from each study participant and all authors read the manuscript and agreed for publication.

Acknowledgment

We would like to thank SPHMMC for financial support and all study participants for their valuable time and commitment. The authors also would like to thank Geoffrey Woodruff and Scott Lawrence for in-depth editing of the manuscript.

Author Contributions

All authors made a significant contribution to the work reported, whether that is in the conception, study design, execution, acquisition of data, analysis and interpretation, or in all these areas; took part in drafting, revising or critically reviewing the article; gave final approval of the version to be published; have agreed on the journal to which the article has been submitted; and agree to be accountable for all aspects of the work.

Disclosure

The authors report no conflicts of interest for this work.

Additional information

Funding

The study was funded by SPHMMC and funding was used for data collection, processing, write up and statistician consultation. The funder had no role in the study.