Simultaneous versus sequential surgery for bilateral congenital cataracts in a resource-limited setting

Abstract

Background: To compare simultaneous surgery with sequential surgery for the treatment of bilateral congenital cataracts in children younger than three years at a tertiary hospital in a resource-limited setting in order to facilitate informed decisionmaking by parents and healthcare providers. Methods: A retrospective review of medical records of children below three years who had bilateral surgery for congenital cataracts between 2010 and 2016 at the pediatric ophthalmology unit of a university teaching hospital in Nigeria. Data on demographic characteristics, type of surgery, delays in care, time interval between surgery and optical rehabilitation, direct cost of care, systemic associations and surgical complication s were retrieved, descriptively summarized and compared for both groups. Results: There were 40 eligible patients, 25 (62.5%) of which were males. Age at presentation ranged from 4-128 weeks with a median of 28 weeks. Twenty-four (60%) patients had simultaneous bilateral cataract surgery. Patients who underwent sequential cataract surgery had higher direct costs and accumulated hospital stay, and were more likely to experience delays in accessing second procedures as well as post-operative optical rehabilitation. No anesthetic or other serious ocular complications such as endophthalmitis were noted in either group. Conclusion: Although there were similarly low complication rates in both groups, we observed higher direct costs of care, longer duration of hospital stay, as well as longer intervals before second surgeries and visual rehabilitation in the sequential group. Therefore, simultaneous cataract surgeries may be the preferable option in resource-limited settings like ours, where health care financing is mainly through out-of-pocket expenses.