Article Text

Download PDFPDF
Does prospective monitoring improve cataract surgery outcomes in Africa?
  1. D Yorston1,
  2. S Gichuhi2,
  3. M Wood3,
  4. A Foster4
  1. 1Department of Epidemiology and International Eye Health, Institute of Ophthalmology, Bath Street, London EC1V 9EL, UK
  2. 2Kikuyu Eye Unit, Kikuyu, Kenya
  3. 3CCBRT Eye Hospital, Dar-es-Salaam, Tanzania
  4. 4London School of Hygiene and Tropical Medicine, Keppel Street, London WC1E7HT, UK
  1. Correspondence to: Dr David Yorston, Department of Epidemiology and International Eye Health, Institute of Ophthalmology, Bath Street, London EC1V 9EL, UK; dhyorston{at}


Aims: To determine if prospective monitoring influences cataract surgical outcomes in east Africa.

Methods: A prospective observational study of all routine extracapsular cataract extractions with posterior chamber lens implants carried out at Kikuyu Eye Unit, Kenya, between 1 January 1999 and 31 December 1999.

Results: Out of 1845 eligible eyes 1800 were included in the study. Two months' follow up was available in 67.2% of patients. The proportion achieving a good outcome increased steadily from 77.1% in the first quarter to 89.4% in the fourth quarter (χ2 for trend, p<0.001). There was no change in the incidence of operative complications; however, the proportion of patients achieving a good visual outcome following vitreous loss increased from 47.2% in the first 6 months to 71.0% in the last 6 months (χ2 p<0.05). Of the eyes with poor outcome (best corrected acuity <6/60 at 2 months) half were due to pre-existing eye diseases. The proportion of patients with known ocular comorbidity decreased from 10.2% in the first quarter to 5.9% in the fourth quarter (χ2 for trend, p<0.05). Poor outcome was associated with age over 80 years, known diabetes, preoperative bilateral blindness, any ocular comorbidity, and intraoperative vitreous loss.

Conclusions: This study demonstrates improvement in visual outcome results after cataract surgery over a 1 year period. Monitoring of outcomes appears to be associated with a change in surgeons' attitudes, leading to greater emphasis on appropriate case selection, better management of surgical complications, and improved visual outcomes.

  • cataract surgery
  • Africa
  • monitoring

Statistics from

Request Permissions

If you wish to reuse any or all of this article please use the link below which will take you to the Copyright Clearance Center’s RightsLink service. You will be able to get a quick price and instant permission to reuse the content in many different ways.