Causes of Suboptimal Cataract Surgical Outcomes at Nkhoma Hospital, Malawi: A Retrospective Analysis
Abstract:
Background: Cataract remains the leading cause of blindness worldwide, particularly in low- and middle- income countries. Cataract surgery is an effective intervention, but poor outcomes reduce its impact in eliminating avoidable blindness. Assessing cataract surgical outcomes is essential for improving surgical quality. This study aimed to identify reasons for poor cataract surgical outcomes at Nkhoma Hospital, Malawi.
Methods: A retrospective analysis of 828 patients with a post-operative visual acuity of 6/18 or worse in at least one eye following cataract surgery. Data were extracted from theatre records, including demographics, referral source, preoperative examination, intraoperative findings, and postoperative assessment. Reasons for poor or borderline outcomes were classified based on ocular comorbidities, refractive error, surgical complications, and screening errors.
Results: 52.2% had ocular comorbidities (e.g., glaucoma, diabetic retinopathy, corneal scarring), which adversely affected vision post-surgery. Uncorrected refractive error accounted for 25.8% of cases, indicating gaps in post operative optical correction services. In 13.5% of cases, records lacked sufficient data to determine a cause. A significant gender disparity was observed (p = 0.027), with women more likely than men to present as blind at the time of surgery.
Conclusion: Poor cataract surgery outcomes are multifactorial, mainly driven by pre-existing ocular conditions, inadequate screening, and post-operative refractive care. Targeted capacity building for cataract surgeons, outreach teams, and post-op follow-up staff is essential to ensuring equitable access to cataract surgery and reducing avoidable blindness in Malawi and other countries.
