Challenges in the management of paediatric cataract in a developing country

AIM:To review the management of cataract in children in a tertiary hospital in a developing country,and to highlight the challenges therein.· METHODS:The hospital records of children aged 15 years or less that had cataract surgery at University of Nigeria Teaching Hospital,Enugu from 2005 to 2008 were reviewed retrospectively.Information was obtained on bio-data,pre-and post-operative visual acuity(VA),biometry,and type of surgery,use of intraocular lens(IOL) and presence of co-morbidity.SPSS was used for data entry and analysis.· RESULTS:The hospital records of 21 children(26 eyes) were analyzed.There were 12 males(57.1%) and 9 females(42.9%).Pre-operative VA could not be assessed in 11 eyes(42.3%),14 eyes(53.9%) had VA <3/60 and one eye(3.8%) had VA 6/60.Biometry was done in only 5 eyes(19.2%).All eyes had standard extracapsular cataract extraction without primary posterior capsulectomy;12 eyes(46.2%) had posterior chamber intraocular lens(PC-IOL) implant while 13 eyes(50.0%) had no IOL.After 12 weeks of follow up,vision assessment was available in only 15 eyes.With best correction,VA of 6/18 or better was achieved in only 5 eyes(33.3%).· CONCLUSION:Inadequate facilities and inadequate follow up after surgery are some of the challenges in managing paediatric cataract in the developing countries.If these challenges are not addressed,cataract will remain a major cause of childhood blindness and low vision in Africa for many years.There should be collaboration between Paediatric Ophthalmology Centres in industrialized and developing countries to enhance skill transfer.Governmental and International Non-governmental Organizations can go a long way to facilitate this exchange.

Cost of pediatric cataract surgery in Maharashtra,India

AIMTo calculate the direct cost of pediatric cataract surgery, from the provider's perspective.

生命早期及儿童期影响因素对年龄相关性白内障的影响

目的：评价生命早期及儿童期影响因素与成人年龄相关性白内障（ age-related cataract,ARC）发病的关系,为早期预防、早期发现、早期治疗ARC提供理论依据。 方法：我院2011-04/2012-10开展以医院为基础的病例对照研究,病例由41-60岁的360例360眼施行白内障摘除术的患者所组成。对照组由与病例的年龄和性别进行匹配、因罹患各种与ARC无关的疾病、同期入住相同医院的360例非白内障的患者所组成。采用自制的调查问卷对所有研究对象进行调查,包括研究对象的一般状况、生命早期影响因素,以及儿童期暴露因素。采用非条件Logistic回归模型对结果进行分析。 结果：出生时胎龄越早,出生时体质量越低,均与发生ARC的危险性具有显著性关联（分别为 OR =1.152,95%CI：1.029-2.235, P=0.024；OR=1.374,95%CI：1.156-2.581,P=0.037）；母亲孕前糖尿病（ OR=1.587,95%CI：1.177-2.915,P =0.019）、孕期糖尿病（OR =1.763,95%CI：1.375-2.367,P =0.004）、先兆子痫（ OR=1.581,95%CI：1.139-1.996,P=0.021）,以及妊娠期高血压（OR=1.517,95%CI：1.032-1.963, P=0.024）均可使发生ARC的危险性升高；而儿童期的影响因素只有10岁时的身高低于同龄儿童和体质量高于同龄儿童才与发生ARC危险性具有十分显著性关联（分别为 OR=1.329,95%CI：1.072-2.351,P=0.038；OR=2.302,95%CI：1.323-3.196,P=0.011）。 结论：出生时胎龄越早、低体质量出生、母亲孕前糖尿病、孕期糖尿病、先兆子痫、妊娠期高血压、10岁时身高较矮,以及体质量升高均是ARC发病的危险因素。但需要进一步开展历时长、大规模的前瞻性研究,以证实我国人群ARC的早期危险因素。

印度马哈拉施特地区儿童白内障的手术费用(英文)

目的:评估儿童白内障手术患者所需的直接费用。方法:在印度西部的一个综合社区护眼中心的小儿眼科,使用标准成本评估患者所需的直接费用。固定费用包括外部建设、室内装修、门诊设备及手术室设备、人员、管理和医院维护费用。消耗品费用包括用于手术的材料。同时,计算患者的直接费用。结果:门诊检查平均直接费用为印第安卢比(Rs.) 69( $1.77)。手术室设备使用费用为Rs.606 ( $15.53),而职工工资为Rs. 2427 ( $62.23)。根据诊治记录计算得出消耗品费用在Rs.1452( $37.23)到15267( $391.46)范围之间。而儿童白内障手术每只眼睛所需平均费用从Rs.4722 ( $122)到Rs.18537 ( $475)不等。结论:儿童白内障患者手术费用在较大的范围内变动。小儿眼科医生应以最节约有效的治疗方案达到手术消耗品的费用合理化。

Three-year follow up of primary health care workers trained in identification of blind and visual impaired children in Malawi

Background: Control of blindness in children is one of the priorities of VISION 2020. Early detection of children needing eye services is essential to achieve maximum visual recovery. Even though training primary (community) Health care workers (PHC) should play an important role in early identification of children, it is not known how many of these workers leave after being trained, and whether those who remain continuing identifying children in the long term. The objectives of the study were to determine the attrition of primary health workers over a 3-year period after training, and to assess their knowledge and skills on cataract in children in southern Malawi. Methods: This was a cohort study that followed primary health care workers (health surveillance assistants) over a 3-year period from 2008 to 2011 and reassessed their attrition rates, knowledge and skills on cataract in children. Results: Among the 59 HSAs that were originally trained in 2008, 54 (92%) were interviewed and were found to be still working in the health sector. Knowledge regarding cataract blindness in children remained constant over the 3-year period, however, only two HSAs had reported identifying and referring children. Conclusion: Despite attrition among primary health care workers being low, only a few actually identify cataract children in the communities after being trained. Other innovative ways are needed to identify prevalent and incident cases in Malawi, as the use of HSAs is unlikely to be successful in addressing blindness in children.

婴幼儿白内障摘除术后青光眼的患病率及危险因素

婴幼儿白内障术后青光眼是一种迟发性白内障术后并发症，患病率依随访时间的延长而升高。其患病相关危险因素有：患儿接受白内障手术时的年龄、小角膜、中央角膜厚度、持续性胎儿血管化、白内障手术过程以及遗传因素等。一期后房植人人工晶状体可能是保护性因素。多数治疗方式效果欠佳，目前青光眼引流物植入术仍是治疗该病的较有效方式。为减少本病患儿视功能损害，应加强白内障患儿手术后随访。

北京市盲人学校学生30年间视觉障碍与致盲原因纵向变化的调查研究

目的调查北京市盲人学校在校学生视力状况与致盲原因并对比研究30年间的纵向变化。方法于2019年7月对北京市盲人学校110例在校学生进行横断面调查。其中,男性76例,女性34例;年龄7-33岁,平均年龄(15.6±5.1)岁。参考世界卫生组织(WHO)防盲计划盲与低视力儿童检查记录表格和工作手册设计调查表。通过家长问卷形式采集并详细记录学生的基本信息、眼病史、全身病史、出生史和家族遗传史等。所有学生集中完成远近视力、裂隙灯显微镜和眼底照相等眼部系统检查。根据WHO标准对视觉障碍程度进行评级。综合病史和眼科检查结果,选择主要因素作为致盲或视觉障碍的原因。对比1989年和2000年的调查结果比较学生视觉障碍和致盲原因30年的纵向变化。性别、病因及视觉障碍程度等计数资料以例数和百分比描述,年龄以范围及均数±标准差描述,对3次调查结果采用列表方式进行比较。结果在110例受检学生中,盲、重度视觉障碍及中度视觉障碍分别有87例、20例和3例,分别占79.1%、18.2%和2.7%。导致视觉障碍的解剖部位依次为玻璃体和(或)视网膜、视神经、全眼球、晶状体、角膜及脑源性,分别有39例、30例、11例、11例、6例和5例,分别占35.5%、27.3%、10%、10%、5.5%及4.5%。排列前3位的主要致盲和重度视觉障碍的眼部疾病为先天性青光眼、先天性白内障、视神经萎缩和视网膜色素变性,分别有14例、10例、10例及9例,分别占12.7%、9.1%、9.1%及8.2%。可避免盲和重度视觉障碍者共计57例,占51.8%。其中,可预防病因和可治疗病因者分别为15例和42例,分别占13.6%和38.2%。对比1989年、2000年和2019年3次调查的结果,盲在盲校学生中所占的比例由58.9%升至79.1%,而致盲和重度视觉障碍最主要的原因均为先天性和遗传性因素。其中,先天性青光眼由第3位上升为第1位致盲眼病。结论先天性眼病和遗传性眼病仍然是北京市盲人学校学生中导致盲和重度视觉障碍的主要原因,应加强对这类疾病的早期诊断和规范治疗。推进儿童眼病筛查和低视力康复是儿童盲防治工作的重点。