Pediatric cataract surgery in Malawi

Purpose: The aim of this study was to evaluate the postoperative refractive status after pediatric cataract surgery with age-determined intraocular lens (IOL) implantation in children (age 0-8 years) in Malawi. Materials and methods: Hospital-based retrospective study from January to June 2011 analyzing age, sex, origin, type of cataract surgery, IOL power and postoperative refractive status. In the absence of biometry, IOL powers were chosen according to the child's age and IOL availability. Results: A total of 58 eyes from 33 children were surgically treated of which 25 (76 %) were bilateral and 8 (24 %) unilateral. Best refractive outcome was achieved with a 25 diopter (D) IOL implanted in children 5-8 years old. None of the children aged 1-7 years achieved the previously calculated target refraction. Results showed a marked myopic variability. The range of postoperative refraction was from - 15 D to + 12.5 D and a large number of children (n=11, 33 %) did not attend for follow-up. Conclusion: Implanting IOLs according to age groups is not a suitable surgical strategy even in resource-poor settings. Refractive outcomes were too variable with a marked myopic shift. Biometry and keratometry are required in order to undertake pediatric cataract surgery. Developing regional pediatric centres should be a focus of the VISION 2020 initiative. © 2013 Springer-Verlag Berlin Heidelberg.