The Outcomes of Paediatric Cataract Surgery with Intraocular Lens Insertion in Sub-Saharan Africa: A Systematic Review

Author: Mhango PP, Zungu TL, Nkume HI, Musopole A, Mdala SY. 

Geographical coverage: Kenya, Tanzania, The Gambia, Nigeria, Zambia, South Africa and Ethiopia.

Sector: Cataract surgery

Sub-sector: Visual outcomes

Equity focus: Not reported

Study population: Children with cataract

Review type: Effectiveness review

Quantitative synthesis method: Meta-analysis

Qualitative synthesis method: Not applicable

Background:

Paediatric cataract is a leading cause of childhood blindness in sub-Saharan Africa (SSA). With declining corneal blindness owing to immunisation programmes and vitamin A supplementation, cataract now accounts for a greater proportion of visual loss in children. Prompt surgery is vital to prevent amblyopia, yet optimal practice—especially the timing of intra-ocular lens (IOL) implantation in infants—remains debated. Post-operative refractive correction (spectacles or contact lenses) and amblyopia therapy (e.g. patching) are also critical but inconsistently delivered. Comprehensive regional evidence on surgical outcomes is therefore limited.

Objective:

To determine visual outcomes in children who underwent cataract surgery with primary IOL implantation in SSA.

Main findings:

Eight studies were included qualitatively; seven (conducted in Kenya, Tanzania [n = 2], The Gambia, Nigeria, Zambia, South Africa and Ethiopia) contributed to meta-analysis. Study durations ranged from 12 to 58 months.

The proportion of eyes achieving a good visual outcome (definition varied across studies) ranged from 16.5 % to 62 %, with a pooled short-term estimate of 31 % (95 % CI 20 % to 42 %). Comparable studies from middle- and high-income countries reported 41 %–91 %.

Complications:

• • Acute fibrinous uveitis: 1.3 %–30.5 %; pooled estimate 12 % (95 % CI 2 % to 21 %).
  • Posterior capsular/visual-axis opacification: pooled estimate 13 % (95 % CI 5 % to 22 %).

Methodology:

PubMed, Embase, Scopus and Web of Science were searched for primary studies (1990–2020) reporting outcomes of cataract surgery with primary IOL implantation in children aged 0–16 years in SSA. English-language articles or those with an English translation were eligible. Two reviewers independently screened records, extracted data and assessed quality using the JBI checklist; disagreements were resolved by discussion or a third reviewer. Random-effects meta-analysis pooled outcome proportions; heterogeneity was examined with the I² statistic, and subgroup analyses explored age and IOL type.

Applicability / external validity:

Outcomes in SSA are generally poorer than in wealthier settings, largely because of delayed presentation, limited follow-up and inadequate visual rehabilitation. Significant heterogeneity, short follow-up and missing data on amblyopia therapy and spectacle use restrict the generalisability of pooled estimates. Longer-term prospective studies are needed.

Geographic focus:

Included studies were carried out in Kenya, Tanzania, The Gambia, Nigeria, Zambia, South Africa, and Ethiopia.

Summary of quality assessment:

There is medium confidence in the review’s conclusion. Searches were comprehensive and inclusion criteria explicit; dual-reviewer screening and quality appraisal were employed, and meta-analysis was appropriate. Limitations include English-language restriction, absence of an excluded-studies list and no analysis stratified by risk of bias.