Abstract
Paediatric cataract surgery is associated with several complications among which is high ocular inflammatory response. Conventionally immediate post-operative subconjunctival steroid with adjuvant systemic and frequent topical steroids have been used to control post-operative inflammation. Studies have reported the advantage of intracameral dexamethasone in decreasing postoperative inflammation. Aim: To evaluate the clinical outcome of intracameral dexamethasone in paediatric cataract surgery in Evangelical Church of West Africa (ECWA) Eye Hospital, Kano. Method: This was a prospective study of 694 paediatric cataract surgeries from January 2006 to December 2014. All the patients were given intracameral dexamethasone 0.4 mg (0.1 ml) immediately after surgery. Each patient had surgical intervention on one eye. Evaluation was done on first, third postoperative day, one week and four weeks later (follow up visits). Outcomes were measured on the fourth week post-operation. Examination of children was done with help of slit lamp for cells, flare or any other sign of inflammation. In case of non-cooperative children examination was done with microscope under sedation/general anaesthesia for fibrinous reaction, exudative membrane, posterior synechiae and red reflex. Results: There were total of 694 patients with age range of 0 to 11 years. Mean age of participants was 2.03 ± 2.5 years. The mean duration of cataract before presentation to the hospital was 5.7 ± 4.3 months with a range of 0 to 16 months. Post operative complications, likely to be associated with intracameral dexamethasone were corneal opacity (0.6%) and raised intraocular pressure (12.5%). In 31 patients (4.5%) there was no post operative complication. Conclusion: Intracameral injection of dexamethasone has a role in preventing immediate postoperative anterior uveitis in paediatric cataract but may not be without complication.
Highlights
Cataract blindness is the leading cause of preventable blindness world-wide
Likely to be associated with intracameral dexamethasone were corneal opacity (0.6%) and raised intraocular pressure (12.5%)
Over 93% subjects had visual improvement, this improvement in vision could not be attributable to the intracameral injection only but more to the phacoemulsification cataract surgery
Summary
It has been estimated that cataract accounted for 47.8% of the 37 million people who were blind worldwide in 2002 [1]. In Nigeria, 75 million are estimated to be children under 15 years, out of which 75,000 (1%) are blind from various causes, the leading cause of which is cataract [2] [3]. The main treatment option for cataract is surgery. Cataract surgery by phacoemulsification is available in few centres. Paediatric cataract surgeries are often attended with post operative complications such as uveitis, glaucoma, posterior capsule opacification, retinal detachment to mention but few. Post operative uveitis can lead to complications like peripheral anterior synechiae, posterior synechiae, exudative membrane and pupil block glaucoma, hampering good vision and prolonging rehabilitation period [4]
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