[Development of oculoplastic surgery in Kinshasa (capital of Democratic Republic of Congo)]

Bilateral paediatric cataract surgery - outcomes of 298 children from Kinshasa, the Democratic Republic of the Congo

INTRODUCTION

The leading cause of childhood blindness globally is paediatric cataract. Bilateral cataract surgery can help to improve visual performance and to diminish the burden of childhood blindness.

OBJECTIVE

To report in a retrospective observational cohort study the long-term outcomes of 298 children who had bilateral cataract surgery with IOL implantation from 2001-2016 in Kinshasa.

METHODS

A standardized surgical treatment of paediatric cataract was practiced on 298 children. Patient's follow-up, complications, and visual outcomes were recorded and analysed.

RESULTS

The mean age was 5.7 ± 4.3 years and males were predominant (64.9%). Most of children were living mainly in urban poorest areas (96.3%). Strabismus, nystagmus and microcornea were encountered in 20.1%, 25.1% and 8.7% of children, respectively. Using WHO criteria most of patients were classified as blind preoperatively and 81.9% of them had improved visual outcomes after surgery. Main reasons for reduced vision during follow-up were secondary cataract (5.7%), IOL decentration (1.2%), retinal detachment (1.2%), and secondary glaucoma (1.5%).

CONCLUSION

In spite of the post conflict challenges, elimination of cataract blindness in children remains a priority. Children present at a late age for surgery and long term follow-up is poor. There is need for program strengthening in these areas.

Oculoplastic surgical services in Nigeria: status and challenges

PURPOSE

To assess the status and challenges of oculoplastic surgical services in Nigeria.

METHODS

An IRB-exempt, web-based survey was distributed to Ophthalmological Society of Nigeria members via e-mail. Information regarding demographics, type and location of practice, subspecialization training, availability and barriers of oculoplastic surgical services, pattern of oculoplastic diseases and surgical procedures was obtained. Responses were analyzed using standard statistical methods.

RESULTS

Forty-four percent (155/356) of ophthalmologists invited completed the online survey. Of these respondents, 104 (67.1%) do provide oculoplastic surgical services with 8 (5.2%) trained in oculoplastic surgery. Respondents reported most commonly treating eyelid trauma (98.1%), orbital inflammatory diseases (92.1%) and lacrimal system disorders (86.5%) with globe removal procedures (98.1%), eyelid reconstruction (92.1%) and lacrimal drainage procedures (84.5%) being the most common procedures performed in their practices. Barriers to availability of oculoplastic surgical services identified by respondents were few trained oculoplastic surgeons (92.9%), lack of training centers (70.3%) and accessibility of services (60%). On multivariable analysis, predictors of availability of oculoplastic surgical services were greater number of years in practice (P < 0.001) and subspecialty training (P < 0.001).

CONCLUSIONS

The availability and geographical distribution of oculoplastic surgical services in Nigeria are suboptimal with training deficiencies identified as the main challenge. Strategies to improve availability of oculoplastic care should entail a sustainable training program for this emerging subspecialty and physician deployment to under-resourced areas of the country.

[German ophthalmology in developing countries : Partnerships with eye clinics in developing countries - an initiative of the German Ophthalmological Society]

In 1999 the global initiative "Vision 2020 - The Right to Sight" was established by the World Health Organization (WHO), the International Agency for the Prevention of Blindness (IAPB) and several non-governmental organizations (NGOs) with the goal of reducing avoidable blindness. Based on this initiative, the working group "International Ophthalmology" of the German Ophthalmological Society (DOG), which was established in 1994, was converted into a DOG section with the same name in 2004 and represents one of the core components of the DOG; however, even before there were a number of established partnerships of German and African eye hospitals. The first cooperation of this kind was the partnership between the Department of Ophthalmology, Ludwig-Maximilians University Munich and the University of Nairobi, Kenya, which was founded in 1978. As a result of this cooperation, the Department of Ophthalmology in Nairobi has evolved into one of the major centers of ophthalmological training and ophthalmic care in East Africa. Since then a number of similar cooperation projects between several hospitals and numerous further projects (e. g. in Myanmar) have been implemented and some of these are presented in this manuscript.