Incidence and Factors Associated with Visual Axis Opacification Following Pediatric Cataract Surgery at Kilimanjaro Christian Medical Centre, 2013-2023

Abstract

Background: Pediatric cataract remains a major cause of childhood blindness worldwide, with visual axis opacification (VAO) representing a frequent and challenging postoperative complication. Objective: To evaluate the incidence and factors associated with VAO following pediatric cataract surgery at Kilimanjaro Christian Medical Centre from January 2013 to January 2023. Methods: We conducted a retrospective cohort study including 345 children (612 eyes) who underwent cataract surgery. Demographic and clinical data were extracted from medical records. Data analysis was performed using STATA version 17. Kaplan-Meier survival curves were used to estimate the probability of VAO over time. Poisson regression models identified factors associated with VAO, with statistical significance set at P< 0.05. Results: Among 345 children, 189 (54.8%) were male, and 267 (77.4%) had bilateral cataracts. The median age at surgery was 28.5 months (range 9-72). The overall incidence of VAO was 19.9% (122/612), corresponding to an incidence rate of 0.251 events per eye-year, with a median follow-up duration of 1 year. Secondary surgeries were performed in 20.3% (124/612) of eyes. Postoperatively, 69.4% of eyes achieved no visual impairment, highlighting the overall success of surgical intervention when VAO is prevented. Significant factors associated with VAO included age at surgery <60 months (AHR = 4.90; 95% CI: 2.77-8.70); P-value<0.001), surgical technique involving lens washout without posterior capsulotomy or anterior vitrectomy (LWO+IOL) (AHR = 7.58; 95% CI: 3.85-14.91); P-value<0.001), and postoperative acute fibrinous reaction (AHR = 5.91; 95% CI: 4.01-8.71); P-value<0.001). Conclusion: The incidence of VAO at KCMC is consistent with global data. Early age at surgery, surgical technique without PPC and AV, and postoperative inflammation were significantly associated with VAO. Adoption of preventive strategies and enhanced postoperative care are critical for improving visual outcomes.