Visual outcomes following pediatric cataract surgery at Komfo Anokye Teaching Hospital in Ghana

Table 1 Number of pediatric cataract surgeries at Komfo Anokye Teaching Hospital from January 1, 2019, to July 31, 2021, grouped by the affected eye, n (%)

Affected eye	Year of surgery			Total
	2019	2020	2021
Both eyes	36 (19.1)	64 (34.0)	88 (46.8)	188 (100.0)
Left eyes	8 (27.6)	7 (24.1)	14 (48.3)	29 (100.0)
Right eye	9 (22.5)	12 (23.5)	19 (24.7)	40 (100.0)
Total	53 (21.5)	83 (31.5)	121 (47.2)	257 (100.0)

n (%) represents the frequency and percentages of pediatric cataract surgeries.

Table 2 Correlation between the visual impairment categories and other variables

Visual impairment categories
Variables	P value
	Right eye		Left eye
	Pre-op VA unaided	Post-op VA aided, 1 year	Pre-op VA unaided	Post-op VA aided, 1 year
Gender	0.413	0.253	0.468	0.07
Age	0.00	0.213	0.00	0.00
Type of cataract	0.00	0.001	0.00	0.00
State of cataract (morphology)	0.00	0.04	0.46	0.00
Postoperative complications	0.00	0.03	0.00	0.77
Postoperative complication intervention	0.00	0.25	0.001	0.98
Refraction (corrected)	0.00	0.00	0.00	0.00

Pre-op VA: Preoperative visual acuity; Post-op VA: Postoperative visual acuity. P value of < 0.05 is considered significant.

Table 3 Details about the cataract surgery grouped by male vs female children, n (%)

Variable	Total	Females	Males
	N = 163 (100%)	N = 67 (41.1%)	N = 96 (58.1%)
Age group (years)
< 2	62 (38.0)	23 (34.3)	39 (40.6)
2 ≤ 10	86 (52.8)	31 (46.3)	50 (52.0)
10-15	15 (9.20)	13 (19.4)	7 (7.3)
Year of surgery
2019	35 (21.5)	14 (20.9)	21 (21.9)
2020	51 (31.3)	21 (31.3)	30 (31.3)
2021	77 (47.2)	32 (47.8)	45 (46.9)
Type of cataract
Congenital	92 (56.4)	30 (44.8)	62 (64.6)
Developmental	31 (19.0)	17 (25.4)	14 (14.6)
Traumatic	26 (16.0)	13 (19.4)	13 (13.5)
Not specified	14 (8.6)	7 (10.4)	7 (7.3)
State of cataract (morphology)
Cortical	3 (1.8)	2 (3.0)	1 (1.0)
Dense	14 (8.6)	6 (9.0)	8 (8.3)
Nuclear	2 (1.2)	1 (1.5)	1 (1.0)
Polar	2 (1.2)	0 (0.0)	2 (2.1)
Not specified	142 (87.1)	58 (86.6)	84 (87.5)
Laterality
Bilateral	94 (57.7)	35 (52.2)	59 (61.5)
Unilateral	69 (42.3)	32 (47.8)	37 (38.5)
Affected eye
Both eyes	94 (57.7)	35 (52.2)	59 (61.5)
Left eye	29 (17.8)	13 (19.4)	16 (16.7)
Right eye	40 (24.5)	19 (28.4)	21 (21.9)
Presenting ocular co-morbidity
Yes	14 (8.60)	5 (7.5)	9 (9.4)
No	149 (91.4)	62 (92.5)	87 (90.6)
Strabismus
Right eye	0 (0.0)	0 (0.0)	0 (0.0)
Left eye	1 (0.6)	0 (0.0)	1 (1.0)
Both eyes	1 (0.6)	1 (1.5)	0 (0.0)
Nystagmus
Right eye	0 (0.0)	0 (0.0)	0 (0.0)
Left eye	0 (0.0)	0 (0.0)	0 (0.0)
Both eyes	7 (4.3)	2 (3.0)	5 (5.2)
Glaucoma
Right eye	1 (0.6)	1 (1.5)	0 (0.0)
Left eye	0 (0.0)	0 (0.0)	0 (0.0)
Both eyes	2 (1.2)	1 (1.5)	1 (1.0)
Corneal opacity
Right eye	0 (0.0)	0 (0.0)	0 (0.0)
Left eye	1 (0.6)	0 (0.0)	1 (1.0)
Both eyes	0 (0.0)	0 (0.0)	0 (0.0)
Leukocoria
Right eye	0 (0.0)	0 (0.0)	0 (0.0)
Left eye	0 (0.0)	0 (0.0)	0 (0.0)
Both eyes	1 (0.6)	1 (1.0)	0 (0.0)
Keratometry
Yes	163 (100.0)	67 (41.1)	96 (58.9)
No	0 (0.0)	0 (0.0)	0 (0.0)
Type of surgical procedure
Small incision	0 (0.0)	0 (0.0)	0 (0.0)
Phacoemulsification	163 (100.0)	67 (41.1)	96 (58.9)
IOL inserted	163 (100.0)	67 (41.1)	96 (58.9)
Postoperative surgical results
Postoperative complications
Yes	16 (9.8)	7 (10.4)	9 (9.4)
No	147 (90.2)	60 (89.6)	87 (90.6)
Glaucoma
Right eye	1 (0.6)	0 (0.0)	1 (0.6)
Left eye	0 (0.0)	0 (0.0)	0 (0.0)
Both eyes	0 (0.0)	0 (0.0)	0 (0.0)
Decentered IOL
Right eye	3 (1.8)	1 (1.5)	2 (2.1)
Left eye	0 (0.0)	0 (0.0)	0 (0.0)
Both eyes	2 (1.2)	0 (0.0)	2 (3.0)
Posterior capsular opacification
Right eye	5 (3.1)	3 (4.5)	2 (2.1)
Left eye	1 (0.6)	1 (1.5)	0 (0.0)
Both eyes	4 (2.5)	1 (1.5)	3 (3.3)
Postoperative complication intervention
Centering IOL	4 (2.5)	2 (3.0)	2 (2.1)
Centering IOL and YAG laser	2 (1.2)	1 (1.5)	1 (1.0)
No intervention needed	148 (90.8)	60 (89.6)	88 (91.7)
Patching	1 (0.6)	1 (1.5)	0 (0.0)
YAG laser	8 (4.9)	3 (4.5)	5 (5.2)
Refraction
Yes	44 (27.0)	17 (25.5)	27 (28.1)
No	119 (73.0)	50 (74.6)	69 (71.9)
Refraction (corrected)
Myopia, add	21 (12.9)	11 (16.4)	10 (10.4)
Mixed (Myopia & Astigmatism)	3 (1.8)	3 (3.1)	0 (0.0)
Mixed (Myopia & Astigmatism), add	3 (1.8)	2 (3.0)	1 (1.0)
Myopia	17 (10.4)	4 (6.0)	13 (13.5)

IOL: Intraocular lens.

Table 4 Classification of preoperative and postoperative visual acuity (best-corrected vision) according to WHO definition of visual impairment, n (%)

Visual impairment category	Visual acuity worse equal to than or better	Right eye, pre VA unaided	Post VA aided 1 year	P value	Left eye, pre VA unaided	Post VA aided 1 year	P value
No VI	6/12	0 (0.0)	25 (15.2)	0.00	0 (0.0)	19 (11.6)	0.00
Mild VI	6/12; 6/18	0 (0.0)	2 (1.2)	0.00	0 (0.0)	5 (3.0)	0.00
Moderate VI	6/18; 6/60	10 (6.1)	0 (0.0)	0.00	6 (3.7)	0 (0.0)	0.00
Severe VI	6/60; 3/60	0 (0.0)	0 (0.0)	0.00	0 (0.0)	0 (0.0)	0.00
Blindness (I)	3/60; 1/60	10 (6.1)	0 (0.0)	0.00	8 (4.9)	0 (0.0)	0.00
Blindness (I)	PL; CF
Blindness (II)	1/60; PL	26 (15.9)	0 (0.0)	0.00	26 (15.9)	0 (0.0)	0.00
Blindness (III)	NPL; NFO	89 (54.6)	0 (0.0)	0.00	82 (50.0)	0 (0.0)	0.00

VI: Visual Impairment; Pre-op VA: Preoperative visual acuity; Post-op VA: Postoperative visual acuity; CF: Counting fingers; PL: Perception of light; NPL: No perception of light; NFO: No following objects. P value of < 0.05 is considered significant.

Table 5 Multivariate regression analysis of factors influencing postoperative visual acuities

Variables	Multivariate regression			P value
	B	SE	95%CI
Postoperative VA RE unaided (1 year)
Age	0.30	0.028	-0.024 to 0.085	0.275
Gender	-0.807	0.341	-1.482 to -0.133	0.019
Type of cataract	0.383	0.162	0.063 to 0.703	0.019
State of cataract (morphology)	-0.302	0.365	-1.022 to -0.418	0.409
Presenting ocular comorbidity	-0.544	0.607	-1.743 to 0.655	0.371
Postoperative complications	0.314	0.584	-0.839 to 1.467	0.591
Postoperative complication intervention	0.377	0.426	-0.464 to 1.218	0.377
Refraction (corrected)	0.597	0.398	-0.189 to 1.383	0.136
Postoperative VA LE unaided (1 year)
Age	0.050	0.028	-0.006 to 0.105	0.078
Gender	-1.162	0.344	-1.841 to -0.484	< 0.001
Type of cataract	0.325	0.163	0.002 to 0.647	0.048
State of cataract (morphology)	-0.017	0.367	-0.741 to 0.708	0.963
Presenting ocular comorbidity	-1.172	0.611	-2.378 to 0.034	0.057
Postoperative complications	0.583	0.587	-0.577 to 1.743	0.322
Postoperative complication intervention	-0.012	0429	-0.859 to 0.834	0.977
Refraction (corrected)	-1.316	0.400	-2.107 to -0.525	0.001
Postoperative VA RE aided (1 year)
Age	0.006	0.005	-0.005 to 0.016	0.298
Gender	-0.045	0.066	-0.176 to 0.086	0.499
Type of cataract	-0.014	0.032	-0.076 to 0.048	0.6659
State of cataract (morphology)	-0.123	0.071	-0.263 to 0.017	0.086
Presenting ocular comorbidity	-0.073	0.118	-0.306 to 0.161	0.539
Postoperative complications	0.093	0.114	-0.132 to 0.317	0.416
Postoperative complication intervention	0.128	0.083	-0.036 to 0.292	0.125
Refraction (corrected)	-0.680	0.077	-0.833 to -0.527	< 0.001
Postoperative VA LE aided (1 year)
Age	0.002	0.005	-0.008 to 0.013	0.666
Gender	-0.150	0.065	-0.279 to -0.021	0.023
Type of cataract	-0.013	0.031	-0.074 to 0.048	0.678
State of cataract (morphology)	-0.220	0.070	-0.357 to -0.082	0.002
Presenting ocular comorbidity	-0.111	0.116	-0.340 to 0.118	0.339
Postoperative complications	0.181	0.112	-0.039 to 0.401	0.107
Postoperative complication intervention	0.00	0.081	-0.161 to 0.161	0.997
Refraction (corrected)	-0.545	0.076	-0.696 to 0.395	< 0.001

VA: Visual acuity; RE: Right eye; LE: Left eye; B: Unstandardized coefficient; SE: Standard Error. P value of < 0.05 is considered significant.