African Experience - Impact Of Cataract Surgeries Performed In Rural Tanzania During Medical Mission

The purpose of our work was to evaluate the efficacy and complications of cataract surgeries performed in Kiabakari, Tanzania during ‘Ophthalmologists for Africa’ medical mission, co-financed by the Polish Aid program of the Ministry of Foreign Affairs of the Republic of Poland over 2 medical missions in 2023 and 2024

We analyzed the outcomes of phacoemulsification surgery in 92 eyes. Mean age of the group was 69.3. Mean glycemia on admission was 5.6 and mean pressure was 148/88. 54 cataracts were mature, 10 were white and 13 posterior subcapsular. 37 eyes had concomitant conditions most often diabetic retinopathy. Surgery was performed in sterile conditions with ESCRS-recommended protocol for antiseptic prophylaxis. Telemedicine was applied to control part of the patients in cooperation with local personnel.

The abovementioned group of eyes has been directly observed for 2 to 3 weeks after the procedure especially in terms of BCVA and IOP profile. The latter have been measured and analyzed by means of the Goldmann applanation tonometry. Further, surgical complications as well as the need for topical and systemic IOP-lowering pharmacotherapy have been analyzed. Subjective ailments reported by the patients in the period of observation have been numbered.

We observed BCVA improvement from 2.00 logMAR before the procedure to 1.40 at first control the day after the surgery, 0.70 at the second control (7 days post-surgery), and 0.70 at the third control (12 days post-surgery). 63 eyes had corneal oedema after the procedure with a mean level of 2+, however it was managed with short-lasting treatment with topical agents. After phacoemulsification, when proper fundoscopy could be performed we diagnosed many patients with previously unsuspected retinal disorders, most prevalently diabetic and hypertensive retinopathy. Other complications such as mild pain and IOP increase were transient. Aphakia was the result of surgery in 1 case.

Insufficient equipment and limited accessibility to ophthalmological services in developing countries pose a real challenge. Stationed in north-western Tanzania we operated on patients from as far as northern Uganda. Cataract surgery greatly contributes to the improvement of the quality of life. The main cause of poor visual outcome in patients was unsuspected co-morbidity, diagnosed only after cataract phacoemulsification. The subjective ailments reported by patients, as well as frequency of complications have been found to be at an acceptable level, not greatly different from surgeries performed in developed western countries, which among others proves the effectiveness of the ESCRS-recommended antiseptic prophylaxis protocol.