Causes, epidemiology, and long-term outcome of traumatic cataracts in children in rural India.

Autor/Urheber	Parikshit Gogate; Mohini Sahasrabudhe; Mitali Shah; Shailbala Patil; Anil Kulkarni
Institution	Wolters Kluwer Medknow Publications
Titel	Causes, epidemiology, and long-term outcome of traumatic cataracts in children in rural India.
Quelle	In: 0301-4738; 1998-3689; doi:10.4103/0301-4738.100557; Indian Journal of Ophthalmology, Vol 60, Iss 5, Pp 481-486 (2012)(2012) PDF als Volltext kostenfreie Datei
Sprache	englisch
Dokumenttyp	online; Zeitschriftenaufsatz
DOI	10.4103/0301-4738.100557
Schlagwörter	Diabetes-related blindness; diabetic retinopathy; key informant; rapid assessment of avoidable blindness; retinopathy of prematurity; tele-ophthalmology; Blindness; disability; equity; health economics; health policy; health and development; social exclusion; Community eye health; prevention of blindness; ophthalmogical residency; VISION 2020; Visual impairment; inequality; social class; income; educational status; gender and ethnic groups; Advocacy; effective service delivery; enabling environment; stakeholders; resources; Avoidable blindness and visual impairment; impact; scaling up; Global blindness; prevalence; visual acuity; Comprehensive eye care; eye care model; pyramidal model; optometrist; optometry regulation; eye health; India; Economics; market; government; cost; Millennium development goals; eye care services; planning rapid assessment methods; Avoidable blindness; cataract surgical rate; corneal blindness; Compliance; services; Human resource development; service delivery; social entrepreneurship; uncorrected refractive error; cataract extraction; cataract; coverage; data aggregation; population; Case detection; comprehensive eye examination; developing countries; glaucoma; integrated approach; training requirements; Child health policy; childhood blindness; social determinants of eye health; Access; Asia-pacific; funding; low vision; policy; vision research priorities; peer review; research; Cataract surgery; clinical outcome; patient-reported outcome; quality improvement; quality; Global eye health; health interventions; health systems; systems thinking; global cost; health investment; primary and secondary health; Trauma; pediatric cataract; visual outcome; Ophthalmology
Abstract	Purpose : To describe preoperative factors, long-term (>3 years) postoperative outcome and cost of traumatic cataracts in children in predominantly rural districts of western India. Subjects : Eighty-two traumatic cataracts in 81 children in a pediatric ophthalmology department of a tertiary eye-care center. Materials and Methods : Traumatic cataracts operated in 2004-2008 were reexamined prospectively in 2010-2011 using standardized technique. Cause and type of trauma, demographic factors, surgical intervention, complications, and visual acuity was recorded. Statistical Analysis : Data analysis done by using SPSS (Statistical package for social sciences) version 17.0 We have used Chi-square test, Fisher′s exact test, paired t-test to find the association between the final vision and various parameters at 5% level of significance; binary logistic regression was performed for visual outcome ≥6/18 and ≥6/60. Results : The children were examined in a 3-7 year follow-up (4.35 ± 1.54). Average age at time of surgery was 10.4 ± 4.43 years (1.03 to 18). Fifty (61.7%) were boys. Forty (48.8%) were blunt and 32 (39%) were sharp trauma. The most common cause was wooden stick 23 (28.0%) and sharp thorn 14 (17.1%). Delay between trauma and presentation to hospital ranged from same day to 12 years after the injury with median of 4 days. The mean preoperative visual acuity by decimal notation was 0.059 ± 0.073 and mean postoperative visual acuity was 0.483 ± 0.417 (P < 0.001). Thirty-eight (46.3%) had best corrected visual acuity (BCVA) ≥6/18 and 51 (62.2%) had BCVA ≥ 6/60. In univariable analysis, visual outcome (≥6/18) depended on type of surgery (P = 0.002), gender (P = 0.028), and type of injury (P = 0.07)-sharp trauma and open globe injury had poorer outcomes; but not on age of child, preoperative vision, and type of surgeon. On multivariable binary logistic regression, only gender was significant variable. Of the 82 eyes, 18 (22%) needed more than one surgery. The parents spent an average of Rs. 2250 ($45) for the surgery and 55 (66.4%) were from lower socio-economic class. Conclusion : The postoperative visual outcomes varied and less than half achieved ≥ 6/18.
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