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Introduction: Cataract is the main cause of blindness among children in Africa, replacing vitamin A deficiency and measles thanks to successful immunization programs. The leading cause of childhood blindness globally is paediatric cataract. Bilateral cataract surgery can help to improve visual performance and diminish the burden of childhood blindness.

Objective: This retrospective observational cohort study reports the long-term outcomes of 298 children who had bilateral cataract surgery with IOL implantation from 2001-2016 in Kinshasa, Democratic Republic of the Congo.

Methods: A standardized surgical treatment of paediatric cataract was practiced on 298 children. Patient’s follow-up, complications, and visual outcomes were recorded and analysed.

Results: The mean age was 5.7 ± 4.3 years and males were predominant (64.9%). Most of the children were living mainly in urban poorest areas (96.3%). Strabismus, nystagmus and microcornea were encountered in 20.1%, 25.1% and 8.7% of children, respectively. Using WHO criteria most of patients were classified as blind preoperatively and 81.9% of them had improved visual outcomes after surgery. Main reasons for reduced vision during follow-up were secondary cataract (5.7%), IOL decentration (1.2%), retinal detachment (1.2%), and secondary glaucoma (1.5%). Complications that also negatively influence outcomes can be divided into short-term and long-term. Short-term complications (2.3%) include retinal detachment and IOL decentration. Long-term complications (7.3%) are composed of the groups of secondary glaucoma and secondary cataracts.

Conclusion: In spite of the post-conflict challenges, the elimination of cataract blindness in children remains a priority. Children present at a late age for surgery and long-term follow-up is poor. There is a need for program strengthening in these areas. It is recommended that the incorporation of routine cataract surgical outcome auditing should be performed regularly to monitor outcomes by surgeon. This has been seen to facilitate consist improvement in surgeons and centre surgical outcomes and enhances a reduction in surgical complication over time.