Courtright Paul, Metcalfe Nick, Hoechsmann Alex, Chirambo Moses, Lewallen Susan, Barrows John, Witte Christine
Kilimanjaro Centre for Community Ophthalmology, Kilimanjaro Christian Medical College/Tumaini University, Moshi, Tanzania.
Can J Ophthalmol. 2004 Feb;39(1):25-30. doi: 10.1016/s0008-4182(04)80049-8.
Cataract is the leading cause of blindness in Malawi. We sought to determine the cataract surgical coverage and the outcome of cataract surgery in a rural district in Malawi to assess past performance of cataract surgical services.
From July to October 1999 we conducted a multistage random cluster survey to include 1630 residents aged 50 years or more in Chikwawa District. Visual acuity, cause of vision loss, history of cataract surgery and cause of poor vision (if less than 6/60) were assessed. Cataract surgical coverage, sight restoration rate and outcome were calculated by person and eye and for men and women separately.
We examined 1384 people (84.9% of target). Twenty-one people (12 men and 9 women) (30 eyes) had received cataract surgery. The cataract surgical coverage rate was 35.6% (44.4% for men and 28.1% for women [odds ratio 2.0, 95% confidence interval 0.6-7.0]) at a visual acuity level of 6/60, and 55.3% (60.0% for men and 50.0% for women [odds ratio 1.5, 95% confidence interval 0.3-6.7]) at a level of 3/60. Only one eye of one subject had received an intraocular lens. Presenting visual acuity was 6/18 or better in 7 eyes (23.3%), 6/24 to 6/60 in 7 eyes, and worse than 6/60 in 16 eyes (53.3%). Among the 16 eyes with visual acuity less than 6/60, the vision could be improved in 8 with provision of aphakic spectacles.
Cataract surgical coverage in this population is similar to that reported from other countries in Africa. As in other settings, cataract surgical coverage was lower in women than in men. Poor outcomes in this population are partly due to surgical complications and partly due to a lack of aphakic correction. Surgical promotion programs will need to focus on differentiating intraocular lens surgery from (previously practised) intracapsular cataract extraction surgery.
白内障是马拉维失明的主要原因。我们试图确定马拉维一个农村地区的白内障手术覆盖率及白内障手术的效果，以评估白内障手术服务过去的表现。
1999年7月至10月，我们进行了一项多阶段随机整群调查，纳入奇夸瓦区1630名50岁及以上居民。评估视力、视力丧失原因、白内障手术史及视力差的原因（如果视力低于6/60）。按人、眼分别计算白内障手术覆盖率、视力恢复率及手术效果，并分别对男性和女性进行计算。
我们检查了1384人（占目标人群的84.9%）。21人（12名男性和9名女性）（30只眼）接受了白内障手术。在视力6/60水平时，白内障手术覆盖率为35.6%（男性为44.4%，女性为28.1%[比值比2.0，95%置信区间0.6 - 7.0]）；在3/60水平时，覆盖率为55.3%（男性为60.0%，女性为50.0%[比值比1.5，95%置信区间0.3 - 6.7]）。只有一名受试者的一只眼植入了人工晶状体。术前视力6/18或更好的有7只眼（23.3%），6/24至6/60的有7只眼，低于6/60的有16只眼（53.3%）。在16只视力低于6/60的眼中，8只通过佩戴无晶状体眼镜视力可得到改善。
该人群的白内障手术覆盖率与非洲其他国家报告的情况相似。与其他地区一样，女性的白内障手术覆盖率低于男性。该人群手术效果不佳部分归因于手术并发症，部分归因于缺乏无晶状体矫正。手术推广项目需要专注于区分人工晶状体手术与（以前实施的）囊内白内障摘除手术。
