Practical, short and medium term avenues must be explored to reduce delays of presentation. Public education, training of health workers and counseling efforts in the communities may be necessary to enable children to access services in a timely fashion.
BackgroundRecent reports have suggested a significant change in the causes of blindness in children in low-income countries cataract becoming the leading cause. We aimed to investigate the presentations and surgical outcomes in children with cataract operated at different ages in Tanzania.MethodsWe conducted a prospective study of 228 children aged ≤192 months at three tertiary centres, 177 with bilateral cataracts and prospectively followed them for 1-year postsurgery. We collected demographic, surgical, preoperative and postoperative clinical characteristics using the standard childhood cataract surgical assessment questionnaire. Families were encouraged to return for follow-up by phone with travel reimbursement where necessary.ResultsPreoperatively, 76% bilateral children were blind in the better eye. 86% of children were followed up at 1 year and 54% bilateral children achieved visual acuity of 0.48 logMAR or better in the better eye and 5% were blind. 33% of unilateral children achieved visual acuity of 0.48 logMAR or better and 17% were blind. Preoperative blindness (adjusted OR (AOR) 14.65; 95% CI 2.21 to 97.20), preoperative nystagmus/strabismus (AOR 9.22; 95% CI 2.66 to 31.97) and aphakia (AOR, 5.32; 95% CI 1.05 to 26.97) predicted poor visual outcome in bilateral cases. 9% of 342 refracted eyes had initial postoperative cylinder of 1.5 D or more, as did a similar proportion (11%) of 315 eyes refracted 1 year after surgery. Acute fibrinous uveitis occurred in 41 (12%) eyes.ConclusionThree-quarters of children were blind preoperatively whereas over half had good vision 1-year postoperatively. Preoperative blindness, nystagmus/strabismus and aphakia predicted poor visual outcome, suggesting that cataract density determines density of amblyopia.
Background: Cataract is the commonest cause of childhood blindness in sub Saharan Africa (SSA). The significance of congenital rubella and human cytomegalovirus (HCMV) infection in the etiology is not known. Objectives: We aimed to investigate prevalence of both viruses in cases of congenital cataract and controls. Methods: Lens tissue was collected (from cases), blood and saliva from cases and controls. Using ELISA, we tested blood samples for rubella and cytomegalovirus IgM. Quantitative polymerase chain reaction (qPCR) was also used for detection of the viruses. Results: Cytomegalovirus was detected using qPCR in 72.9% saliva specimens of cases compared to 38.5% of controls (P = 0.0001). Cytomegalovirus IgM was also detected in 10.8% blood specimens of cases and only 1.5% control (P = 0.01). Rubella IgM was detected in 13.8% blood specimens of cases and only 3.1% controls (P = 0.01). In lens aspirates of cases, 12.7% were HCMV positive and 11.1% were rubella positive by qPCR. Cases had lower birth weights (mean = 2.8 kg) than controls (mean = 3.2 kg), independent of viral status (P = 0.004). Conclusions: Although most of the children in the study presented too late to be sure that infection was congenital, our study strongly suggests that HCMV and rubella infection appear important causes of congenital cataract in Tanzania hence virology testing of infantile cataract cases may be useful in assessing effectiveness of immunization programs as they are established throughout SSA.
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