Sir,
We read with interest the recent paper by Gogate et al1 studying the visual outcomes of congenital and developmental cataract surgery, and determining the variables for presentation for pediatric cataract surgery in KwaZulu Natal province of South Africa. Although the study is indeed interesting, there are certain points we wish to highlight. First, what was the incidence of glaucoma postoperatively in the pseudophakic group and in the aphakic group, especially in patients with microphthalmos? No mention of a peripheral iridectomy has been made by the authors, as peripheral iridectomy done intraoperatively in patients with microphthalmos undergoing cataract surgery decreases incidence of glaucoma as seen in the study by Shrikanth et al.2 Second, how many patients had strabismus or nystagmus at presentation? Third, which type of hydrophobic acrylic intraocular lens (IOL) was used in the surgery, single piece or multipiece? What was the site of placement of IOL, in the bag, ciliary sulcus or was the optic captured? Fourth, the authors need to clarify the measures taken to visually rehabilitate the unilateral aphakes postoperatively since that would affect the final visual outcome tremendously. In addition, information such as strategies of amblyopia therapy, adherence to patching and optical correction compliance are lacking. Lastly, the follow-up period of 3-months was very short, leaving many young infants not eligible for reliable visual acuity testing. A longer follow-up of patients is needed to further discuss the surgical outcomes of congenital/developmental cataracts in South Africa.
References
Gogate P, Parbhoo D, Ramson P, Budhoo R, Øverland L, Mkhize N et al. Surgery for sight: outcomes of congenital and developmental cataracts operated in Durban, South Africa. Eye 2016; 30: 406–412.
Prasad S, Ram J, Sukhija J, Pandav SS, Gupta PC . Cataract surgery in infants with microphthalmos. Graefes Arch Clin Exp Ophthalmol 2015; 253 (5): 739–743.
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Gupta, P., Ram, J. Surgery for sight: outcomes of congenital and developmental cataracts operated in Durban, South Africa. Eye 30, 1522–1523 (2016). https://doi.org/10.1038/eye.2016.157
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DOI: https://doi.org/10.1038/eye.2016.157