1. OUTCOME OF AGE-RELATED CATARACT SURGERY IN JUBA MEDICAL COMPLEX Principal Investigator Dr Aja Paul Kuol Supervisors Dr. Marco Sheilla Prof. Jefitha Karimurio Dr. Wani Mena

2. Introduction Cataract is a cloudy patch that develop in the lens of the eye and can cause blurred or misty vision 1,2,3,4 Most cataracts develop when aging or injury changes the tissue that makes up your eye's lens 4 In Africa, cataract is still the leading cause of blindness and its in WHO vision 2020 elimination strategy for avoidable blindness 3 1.Thylefors B, Negrel AD, Pararajasegaram R, Dadzie KY. Global data on blindness. Bull World Health Organ 1995; 73: 115– 21. 2.Kuszak J. Pathology of age-related human cataracts. In: Tasman W, ed. Duane's Clinical Ophthalmology. 2004 ed: Lippincot, Williams & Wilkins 3WHO. VISION 2020 Global Initiative for the elimination of avoidable blindness -Action Plan 2006-2011 [Internet]. WHO; 2007. Available from: www.who.intwww.who.int 4Chitkara D. Cataract Formation Mechanisms In: Yanoff M, ed. Ophthalmology: Mosby 1999:4.8.3-4.8.4

3. Introduction Most age related cataract surgery outcome are poor in sub-Saharan Africa due to patient selection or poor surgical techniques or uncorrected refracted errors among others 5. There is no publications on outcomes of age related cataract surgery In South Sudan, access to cataract surgery may still be a challenge to many patients due to factors such as lack of knowledge/ awareness, lack of funds or specialized practitioners and the techniques. 5.Lumme P, Laatikainen LT. Factors affecting Visual Outcome after cataract surgery. International Ophthalmology 1993; 17:313-319

4. Causes of Poor Outcomes of Age-related Cataract Surgery 5,6,7,8 Late presentation, civil war Poor surgical techniques and loss to follow Refractive error Post-operative complications Other diseases such as corneal scar or even traumatic cataract 5.Lumme P, Laatikainen LT. Factors affecting Visual Outcome after cataract surgery. International Ophthalmology 1993; 17:313-319 6.Cook, C. How to Improve the Outcome of a Cataract Surgery. Community Eye Health, 2000; 13(35): 37–38. 7.Johansen J, Theodorsen FP, Corydon L. Visual outcome following complicated extracapsular cataract extraction. J Cataract Refract Surg 1992; 18: 577–81. 8.Ahmad S. Visual outcome of cataract surgery in a field hospital of sub-Saharan Africa. A journal of Army medical corps. 2011; 2

5. Study Justification The findings will provide the baseline data to assist the hospital and its management in monitoring the outcome of cataract surgery in the region (South Sudan)

6. Study Objectives Main objective To assess the outcome of age related cataract surgery in patients aged 40 years and above performed at Juba Medical Center between March 2011 and March 2014. Specific Objectives To assess the visual outcomes of age-related cataract surgery To determine the complications of age-related cataract surgery To determine the factors associated with poor surgical outcome

7. Methodology Study design Retrospective hospital based case series Study area Juba Medical Complex (JMC) Case definition Any patient aged 40 years and above who had undergone surgery for age related cataract Target population An estimated number of 350 patients have undergone age-related cataract surgery at JMC between March 2011 and March 2014 Study population (sample) Record of all persons age 40 and above went for cataract surgery at JMC Study period 3 year period from March 2011 to March 2014

8. Methodology Sample size Where; n 1 = sample size with finite population correction 9 N= size of the target population = 350 (JMC registry book) Z= statistic for 95% level of confidence =1.96 P= estimated proportion of patients with poor age related surgical outcome = 4.2% (8) d= margin of error =2.1 % = 175 patients 9.Wanga SK, Lemeshow S. Sample size determination in health studies. A practical manual. Ginebra: World Health Organization, 1991.

9. Methodology Inclusion Criteria All the records of persons 40 years and older who had age related cataract surgery at JMC between March 2011 to March 2014 at JMC Exclusion Criteria Missing or incomplete records (age, VA) Record of all persons age less than 40 years at the time of surgery Cataract secondary to trauma Uveitic cataract

10. Methodology Data Collection Structured questionnaires will be used by the principal investigator assisted by a research assistant to record/ collect patients’ data The file/card number of all the patients over 40 years who underwent cataract surgery between March 2011 and March 2014 will be recorded from the theatre surgery record books Pre & post-operative visual examination and suggested possible cause of poor outcome will be recorded Record intra-op and post-op complications Data collection period will be between December 2014 and January 2015

11. Data Management and Analysis Data Management Data entry, cleaning, validation and coding will done on MS Excel Data will be checked for any wrong entry and double entry and corrected Back up will be created in an external hard disk in case of damage and/or loss of original data and it will be password protected Use of coded data will be done to ensure maximum confidentiality At the end of the study, the raw data will be destroyed and deleted from any existing hard copies by paper shredding and formatting and deleting from any soft copy storage devices including computers, flash discs and hard disks

12. Data Management and Analysis Data Analysis Analysis done with STATA version 11 (Stata Corp, College Station, Texas) Descriptive analysis will be done to determine means, frequencies and proportions of the various variables and findings presented by means of graphs, tables and charts where appropriate. Proportionate test will be used to compare proportions. Chi-square will be used to test factors associated with poor outcome. Confidence level will be taken as 95% (p <0.05) where applicable

13. Ethical Considerations Confidentiality The identity of the patients was kept anonymous during data collection. No record of the identity of the patient or file number will be made. No photocopies of medical records will be made. The questionnaires will only be available to the Biostatistician and principal investigator for analysis only who upholds confidentiality and adheres to data protection standards. The coded questionnaires will be destroyed after analyzing the data.

14. Ethical Considerations Approval by the Ethics Committee Written ethical approval to conduct the study will be sought from the Ethics and Research Committee of University of Nairobi and Kenyatta National Hospital for approval. Approval will also be sought from Juba Medical Complex and Ministry of Health in South Sudan for approval.

15. Work Plan Activity20142015 JFMAMJJASONDJFMAM Concept and Preparation of Proposal Presentation to Departmental Faculty Ethical Approval Budget Approval Preparation of Study materials/Training of Assistants Data collection Data Analysis and Results presentation Preparation and Submission of Thesis

16. Thank you (Questions, Additions and Comments)