{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,1,20]],"date-time":"2026-01-20T12:49:21Z","timestamp":1768913361340,"version":"3.49.0"},"reference-count":39,"publisher":"MDPI AG","issue":"9","license":[{"start":{"date-parts":[[2024,8,30]],"date-time":"2024-08-30T00:00:00Z","timestamp":1724976000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/501100003042","name":"Else Kroener Fresenius Stiftung","doi-asserted-by":"publisher","award":["896103"],"award-info":[{"award-number":["896103"]}],"id":[{"id":"10.13039\/501100003042","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/501100003042","name":"Else Kroener Fresenius Stiftung","doi-asserted-by":"publisher","award":["892037"],"award-info":[{"award-number":["892037"]}],"id":[{"id":"10.13039\/501100003042","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/501100012688","name":"University of Rostock","doi-asserted-by":"publisher","award":["896103"],"award-info":[{"award-number":["896103"]}],"id":[{"id":"10.13039\/501100012688","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/501100012688","name":"University of Rostock","doi-asserted-by":"publisher","award":["892037"],"award-info":[{"award-number":["892037"]}],"id":[{"id":"10.13039\/501100012688","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Children"],"abstract":"<jats:p>Background: Childhood blindness remains a neglected issue in eye care within low-income countries, with congenital and juvenile cataracts being the most common treatable causes. This study aims to investigate the factors influencing the management of congenital and juvenile bilateral cataracts, provide data on general outcomes and postoperative findings, and discuss treatment in a low-income country context. Methods: In this prospective study, data from clinical care were continuously entered into a database, and one follow-up examination of a cohort of 91 patients with congenital and juvenile bilateral cataracts in Kinshasa, Democratic Republic of the Congo, was conducted. Multiple factors that affect the first clinical presentation, the clinical management, and outcome were investigated. Results: Most patients (88.5%) who received medical treatment were identified by cataract finders. A patient\u2019s presentation time was independent of the parent\u2019s education, social status, income, and sex of the child. The median age at first presentation was 5.8 years (ranging from 0 days to 17.3 years). The best visual acuity outcomes were achieved by patients who underwent surgery during early childhood. According to WHO grades and on an eye level basis, 51.1% (93 out of 182 eyes) showed improvement, while 34.6% (63 eyes) had unchanged results post-surgery. Among the cases without improvement, 76.2% were blind prior to surgery. Postoperative findings were observed in 56% of the patients, with secondary cataracts being the most common, affecting 26.37% of the operated eyes. Conclusions: Optimal management of childhood cataracts involves early identification, efficient hospital infrastructure, high-quality medical care, and long-term follow up. In sub-Saharan Africa, this approach must be adapted to the context of available resources, which differs significantly from those in high- and middle-income countries.<\/jats:p>","DOI":"10.3390\/children11091064","type":"journal-article","created":{"date-parts":[[2024,8,30]],"date-time":"2024-08-30T06:46:29Z","timestamp":1725000389000},"page":"1064","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":3,"title":["Management of Bilateral Congenital and Juvenile Cataracts in a Low-Income Country: Patient Identification, Treatment Outcomes, and Follow Up"],"prefix":"10.3390","volume":"11","author":[{"given":"Broder","family":"Poschkamp","sequence":"first","affiliation":[{"name":"Department of Ophthalmology, University Medicine Greifswald, Ferdinand-Sauerbruch-Street, 17475 Greifswald, Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Serge","family":"Dinkulu","sequence":"additional","affiliation":[{"name":"St. Joseph Hospital Kinshasa, J8MR+HCR, Kinshasa, Democratic Republic of the Congo"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"name":"Stahnke","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Clara","family":"B\u00f6ckermann","sequence":"additional","affiliation":[{"name":"Institute for Biomedical Engineering, Rostock University Medical Center, Friedrich-Barnewitz-Street 4, 18119 Rostock, Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Edith","family":"Mukwanseke","sequence":"additional","affiliation":[{"name":"St. Joseph Hospital Kinshasa, J8MR+HCR, Kinshasa, Democratic Republic of the Congo"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Christiane","family":"Paschke","sequence":"additional","affiliation":[{"name":"German Committee for the Prevention of Blindness, Schulte-Marxloh-Str. 15, 47169 Duisburg, Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3367-3231","authenticated-orcid":false,"given":"Adrian","family":"Hopkins","sequence":"additional","affiliation":[{"name":"Adrian Hopkins Consulting, GAELF Secretariat, Liverpool School of Tropical Medicine, 76 Venture Court, Gravesend DA12 2AT, UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Rainald","family":"Duerksen","sequence":"additional","affiliation":[{"name":"Christian Blind Mission (CBM), 14, Avenue Sergent Moke Concession Safricas, Ngaliema Kinshasa, Democratic Republic of the Congo"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ellen","family":"Steinau","sequence":"additional","affiliation":[{"name":"Department of Gynaecology, University Medicine Greifswald, Ferdinand-Sauerbruch-Street, 17475 Greifswald, Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Andreas","family":"Stahl","sequence":"additional","affiliation":[{"name":"Department of Ophthalmology, University Medicine Greifswald, Ferdinand-Sauerbruch-Street, 17475 Greifswald, Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Andreas","family":"G\u00f6tz","sequence":"additional","affiliation":[{"name":"Institute for Biomedical Engineering, Rostock University Medical Center, Friedrich-Barnewitz-Street 4, 18119 Rostock, Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Rudolf","family":"Guthoff","sequence":"additional","affiliation":[{"name":"Institute for Biomedical Engineering, Rostock University Medical Center, Friedrich-Barnewitz-Street 4, 18119 Rostock, Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ngoy-Janvier","family":"Kilangalanga","sequence":"additional","affiliation":[{"name":"St. Joseph Hospital Kinshasa, J8MR+HCR, Kinshasa, Democratic Republic of the Congo"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1968","published-online":{"date-parts":[[2024,8,30]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"30","DOI":"10.1038\/eye.2014.239","article-title":"The Barrie Jones Lecture-Eye care for the neglected population: Challenges and solutions","volume":"29","author":"Rao","year":"2015","journal-title":"Eye"},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"1338","DOI":"10.1038\/sj.eye.6702841","article-title":"Changing challenges in the control of blindness in children","volume":"21","author":"Gilbert","year":"2007","journal-title":"Eye"},{"key":"ref_3","first-page":"227","article-title":"Childhood blindness in the context of VISION 2020\u2014The right to sight","volume":"79","author":"Gilbert","year":"2001","journal-title":"Bull. World Health Organ."},{"key":"ref_4","doi-asserted-by":"crossref","unstructured":"Wu, X., Long, E., Lin, H., and Liu, Y. (2016). Prevalence and epidemiological characteristics of congenital cataract: A systematic review and meta-analysis. Sci. Rep., 6.","DOI":"10.1038\/srep28564"},{"key":"ref_5","first-page":"338","article-title":"Cost-effectiveness analysis of cataract surgery: A global and regional analysis","volume":"82","author":"Baltussen","year":"2004","journal-title":"Bull. World Health Organ."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"86","DOI":"10.1016\/j.neubiorev.2020.10.030","article-title":"Neural mechanisms of visual sensitive periods in humans","volume":"120","author":"Kekunnaya","year":"2021","journal-title":"Neurosci. Biobehav. Rev."},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"12","DOI":"10.1080\/0065955X.1988.11981763","article-title":"Vision and Eye Screening in Finland an Overview","volume":"38","year":"1988","journal-title":"Am. Orthopt. J."},{"key":"ref_8","unstructured":"World Health Organization (2019). World Report on Vision, World Health Organization."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"137","DOI":"10.1007\/s00417-008-0926-0","article-title":"Resolving the clinical acuity categories \u201chand motion\u201d and \u201ccounting fingers\u201d using the Freiburg Visual Acuity Test (FrACT)","volume":"247","author":"Lange","year":"2009","journal-title":"Graefe\u2019s Arch. Clin. Exp. Ophthalmol."},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"e963","DOI":"10.1111\/aos.14659","article-title":"A novel excel sheet conversion tool from Snellen fraction to LogMAR including \u2018counting fingers\u2019, \u2018hand movement\u2019, \u2018light perception\u2019 and \u2018no light perception\u2019 and focused review of literature of low visual acuity reference values","volume":"99","author":"Moussa","year":"2021","journal-title":"Acta Ophthalmol."},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"100559","DOI":"10.1016\/j.eclinm.2020.100559","article-title":"An electrophysiological biomarker for the classification of cataract-reversal patients: A case-control study","volume":"27","author":"Sourav","year":"2020","journal-title":"eClinicalMedicine"},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"87","DOI":"10.1097\/ICU.0000000000000324","article-title":"Update on congenital cataract surgery management","volume":"28","author":"Lim","year":"2017","journal-title":"Curr. Opin. Ophthalmol."},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"1811","DOI":"10.1038\/s41433-018-0176-2","article-title":"Delay in presentation to hospital for childhood cataract surgery in India","volume":"32","author":"Sheeladevi","year":"2018","journal-title":"Eye"},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"148","DOI":"10.1007\/s10384-015-0370-8","article-title":"Clinical characteristics of congenital and developmental cataract undergoing surgical treatment","volume":"59","author":"Nagamoto","year":"2015","journal-title":"Jpn. J. Ophthalmol."},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"1360","DOI":"10.1016\/j.jcrs.2012.04.025","article-title":"Complication rates of phacoemulsification and manual small-incision cataract surgery at Aravind Eye Hospital","volume":"38","author":"Haripriya","year":"2012","journal-title":"J. Cataract Refract. Surg."},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"520","DOI":"10.5301\/ejo.5000413","article-title":"Comparison of cataract surgery techniques: Safety, efficacy, and cost-effectiveness","volume":"24","author":"Jaggernath","year":"2014","journal-title":"Eur. J. Ophthalmol."},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"362","DOI":"10.4103\/0974-9233.159763","article-title":"Meta-analysis to Compare the Safety and Efficacy of Manual Small Incision Cataract Surgery and Phacoemulsification","volume":"22","author":"Gogate","year":"2015","journal-title":"Middle East Afr. J. Ophthalmol."},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"676","DOI":"10.1001\/jamaophthalmol.2014.531","article-title":"Comparison of contact lens and intraocular lens correction of monocular aphakia during infancy: A randomized clinical trial of HOTV optotype acuity at age 4.5 years and clinical findings at age 5 years","volume":"132","author":"Lambert","year":"2014","journal-title":"JAMA Ophthalmol."},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"228","DOI":"10.1016\/S0140-6736(10)61458-4","article-title":"Burden of endemic health-care-associated infection in developing countries: Systematic review and meta-analysis","volume":"377","author":"Allegranzi","year":"2011","journal-title":"Lancet"},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"1347","DOI":"10.1038\/s41433-020-1019-5","article-title":"Red reflex examination in reproductive and child health clinics for early detection of paediatric cataract and ocular media disorders: Cross-sectional diagnostic accuracy and feasibility studies from Kilimanjaro, Tanzania","volume":"35","author":"Mndeme","year":"2021","journal-title":"Eye"},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"3007","DOI":"10.1038\/s41433-020-01341-9","article-title":"Identification of amblyogenic risk factors with the Br\u00fcckner reflex test using the low-cost Arclight direct ophthalmoscope","volume":"35","author":"Tuteja","year":"2021","journal-title":"Eye"},{"key":"ref_22","unstructured":"lvpei.tech (2023, January 10). Folding Foropter|lvpei.tech. Available online: https:\/\/www.lvpei.tech\/fofo."},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"83","DOI":"10.4103\/meajo.MEAJO_273_18","article-title":"Role of a Community-based Program for Identification and Referral of Pediatric Cataract Patients in Kinshasa, Democratic Republic of the Congo","volume":"26","author":"Kilangalanga","year":"2019","journal-title":"Middle East Afr. J. Ophthalmol."},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"3803","DOI":"10.4103\/ijo.IJO_1812_22","article-title":"Complications of manual small-incision cataract surgery","volume":"70","author":"Goel","year":"2022","journal-title":"Indian J. Ophthalmol."},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"92","DOI":"10.4103\/0974-9233.148356","article-title":"Pediatric cataract surgery in national eye centre Kaduna, Nigeria: Outcome and challenges","volume":"22","author":"Umar","year":"2015","journal-title":"Middle East Afr. J. Ophthalmol."},{"key":"ref_26","first-page":"77","article-title":"Pediatric cataract: Challenges and future directions","volume":"9","author":"Medsinge","year":"2015","journal-title":"Clin. Ophthalmol."},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"1024","DOI":"10.31729\/jnma.2807","article-title":"Visual Axis Opacification in Children Following Paediatric Cataract Surgery","volume":"52","author":"Shrestha","year":"2014","journal-title":"JNMA J. Nepal Med. Assoc."},{"key":"ref_28","unstructured":"Gupta, P., and Patel, B.C. (2023). Pediatric Cataract. StatPearls [Internet], StatPearls Publishing."},{"key":"ref_29","unstructured":"Roy, F.H., Fraunfelder, F.W., and Fraunfelder, F.T. (2008). Chapter 300\u2014CONGENITAL AND INFANTILE CATARACTS 743.20. Current Ocular Therapy, Saunders. [6th ed.]."},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"55","DOI":"10.1097\/ICU.0b013e32833383cb","article-title":"Update on pediatric cataract surgery and intraocular lens implantation","volume":"21","author":"Lin","year":"2010","journal-title":"Curr. Opin. Ophthalmol."},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"1627","DOI":"10.1136\/bjo.2007.117887","article-title":"Secondary glaucoma after paediatric cataract surgery","volume":"91","author":"Swamy","year":"2007","journal-title":"Br. J. Ophthalmol."},{"key":"ref_32","doi-asserted-by":"crossref","first-page":"117","DOI":"10.1016\/j.jaapos.2006.01.003","article-title":"Incidence and risk factors for glaucoma after pediatric cataract surgery with and without intraocular lens implantation","volume":"10","author":"Trivedi","year":"2006","journal-title":"J. AAPOS"},{"key":"ref_33","doi-asserted-by":"crossref","first-page":"237","DOI":"10.1080\/09286580600672213","article-title":"Predictors of poor follow-up in children that had cataract surgery","volume":"13","author":"Eriksen","year":"2006","journal-title":"Ophthalmic Epidemiol."},{"key":"ref_34","doi-asserted-by":"crossref","first-page":"158","DOI":"10.1016\/j.jaapos.2012.11.009","article-title":"Glaucoma after pediatric cataract surgery in a population with limited access to care","volume":"17","author":"Baden","year":"2013","journal-title":"J. AAPOS"},{"key":"ref_35","doi-asserted-by":"crossref","first-page":"e621","DOI":"10.1111\/aos.14661","article-title":"An update on continuous-wave cyclophotocoagulation (CW-CPC) and micropulse transscleral laser treatment (MP-TLT) for adult and paediatric refractory glaucoma","volume":"99","author":"Souissi","year":"2021","journal-title":"Acta Ophthalmol."},{"key":"ref_36","doi-asserted-by":"crossref","first-page":"414","DOI":"10.3109\/08820538.2014.959192","article-title":"Complications of pediatric cataract surgery","volume":"29","author":"Whitman","year":"2014","journal-title":"Semin. Ophthalmol."},{"key":"ref_37","doi-asserted-by":"crossref","first-page":"1260","DOI":"10.1038\/eye.2016.170","article-title":"Second intraocular surgery after primary pediatric cataract surgery: Indications and outcomes during long-term follow-up at a tertiary eye care center","volume":"30","author":"Sachdeva","year":"2016","journal-title":"Eye"},{"key":"ref_38","doi-asserted-by":"crossref","first-page":"36","DOI":"10.1016\/j.ophtha.2017.07.003","article-title":"Incidence, Risk Factors, and Outcomes of Retinal Detachment after Pediatric Cataract Surgery","volume":"125","author":"Agarkar","year":"2018","journal-title":"Ophthalmology"},{"key":"ref_39","first-page":"e22875","article-title":"Lens-Induced Glaucoma: An Audit of Cataract Cases in Hospital Sultanah Nur Zahirah, Kuala Terengganu (HSNZKT)","volume":"14","year":"2022","journal-title":"Cureus"}],"container-title":["Children"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2227-9067\/11\/9\/1064\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,10]],"date-time":"2025-10-10T15:45:41Z","timestamp":1760111141000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2227-9067\/11\/9\/1064"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2024,8,30]]},"references-count":39,"journal-issue":{"issue":"9","published-online":{"date-parts":[[2024,9]]}},"alternative-id":["children11091064"],"URL":"https:\/\/doi.org\/10.3390\/children11091064","relation":{},"ISSN":["2227-9067"],"issn-type":[{"value":"2227-9067","type":"electronic"}],"subject":[],"published":{"date-parts":[[2024,8,30]]}}}