VISUAL OUTCOMES IN CATARACT SURGERY
Keywords:
WHO- world health organization, SICS- small incision cataract surgery, PCposterior capsule
Abstract
Objective: Analysis of visual outcome in various methods of cataract surgery as per WHO guidelines at a tertiary care centre Design: A Hospital based study on 824 eyes of 824 patients with senile cataract without comorbid ocular or systemic conditions who gave consent.
Materials: Manual SICS with sclerocorneal incision, Manual SICS with Clear Corneal Incision and Phacoemulsification were performed by multiple Ophthalmic Surgeons. Patients were followed up on Days 1, 7, 15 and Months 1, 3, 6 and 12.
Results: Manual small incision cataract surgery with clear corneal tunnel was performed in majority of cases. Out of 824 patients, 781 came for 8 week follow up after surgery. Out of 781 cases, good visual outcome seen in 86.43% patients which meet WHO guidelines. Intraoperative complications (8.25%) were the major cause affecting visual outcome. Intraoperative complications occurred in total 77 (9.8%) patients which short falls of the maximum limit of 10% as per WHO guidelines. Posterior Capsule Rent 30 patient (3.64%) is most common intraoperative complication followed by PC rent with vitreous loss 26 (3.32%). Rate of both complications is well below the maximum limit of 5% as per guidelines given by WHO.
Conclusion: Visual outcome of cataract surgery at our tertiary care hospital fairly meets the WHO guidelines. Intraoperative complications and retained lens material are important causes of low visual outcome at our hospital. This study shows that scope of improvement at our hospital lies in reducing intraoperative & postoperative complications and their management
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References
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2.. Murthy GVS, Gupta SK, Bachani D, Jose R, John N. Current estimates of blindness in India. Br J Ophthalmol 2005;89:257-60
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33. Singer JA. Frown incision for minimizing surgically induced astigmatism after small incision cataract surgery with rigid optic intraocular lens implantation. J cataract refract surg 1991;17:677-88
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41. G P Pokharel, G Regmi, S K Shrestha, A D Negrel, L B Ellwein Prevalence of blindness and cataract surgery in Nepal Br J Ophthalmol1998;82:600–605
42. Anand R, Gupta A, Ram J, Singh U, Kumar R. Visual outcome following cataract surgery in rural punjab. Indian J Ophthalmol 2000;48:153
43. R A Bourne, B P Dineen, S M Ali, D M NoorulHuq, G J Johnson,Outcomes of cataract surgery in Bangladesh: results from a population based nationwide survey, Br J Ophthalmol 2003;87:813–819
44. P M Gogate, M Deshpande, R P Wormald, R Deshpande, S R Kulkarni Extracapsular cataract surgery compared with manual small incision cataract surgery in community eye care setting in western India: a randomised controlled trial.Br J Ophthalmol 2003;87:667–672
45. A R Malik, Z A Qazi, C Gilbert Visual outcome after high volume cataract surgery inPakistan Br J Ophthalmol 2003;87:937–940
46. Lindfield R, Polack S, Wadud Z, Choudhury KA, Rashid AK, Kuper H et al.‘Causes of poor outcome after cataract surgery in Satkhira district, Bangladesh:Eye
(Lond). 2008 Aug;22(8):1054-6.
47. H. C. Obiudu, B. I. Obi, O. C. Anyalebechi Monitoring Cataract Surgical Outcome in a Public Hospital in Orlu, South East Nigeria Niger Med J, 2009: 50:4-5
48. PipatKongsapSutureless large-incision manual cataract extraction using the kongsap technique: outcome of a prospective study int J Ophthalmol 2010; 3(3);241-244
49. Gogate P, VakilV, Khandekar R, Deshpande M, Limburg H Monitoring and modernization to improve visual outcomes of cataract surgery in a community eyecare center in western India.J Cataract Refract Surg. 2011 Feb;37(2):328-34.
50. Guirou N, Napo A, Dougnon A, Bakayoko S, Sidibé F, Sidibé MK, Conaré I, Traoré L, Traoré J.; Visual outcome of cataract surgery in adults’ ;Journal of Evolution of Medical and Dental Sciences 2014; Vol. 3, Issue 06, February 10;J Fr Ophtalmol. 2013 Jan;36(1):19-22. doi: 10.1016/j.jfo.2012.04.016. Epub 2012 Dec 5 Page: 1536-1541, DOI: 10.14260/jemds/2014/2020
51. ChanchlaniMadhu, Sarkar N, Manghani J, Soni B, Chanchlani R. “Evaluation of Visual Outcome after Cataract Surgery in Camp Patients - A Study from Central
India”.
52. Oladigbolu KK, Rafindadi AL, Mahmud-Ajeigbe AF, Chinda D, Pam V, Samaila E.Outcome of cataract surgery in rural areas of Kaduna State, Nigeria. Ann Afr Med 2014:13:25-9
53. Vashist P, Talwar B, Gogoi M, Maraini G, Camparini M. Prevalence of cataract in an older population in India: the India study of age-related eye disease. Ophthalmology. 2011 Feb;118(2):272-8.e12.doi:10.1016/j.ophtha.2010.05.020
54. Murthy GV, Gupta SK, Maraini G, Camparini M, Price GM, Dherani M et al.Prevalence of lens opacities in North India: the INDEYE feasibility study Invest Ophthalmol Vis Sci. 2007 Jan;48(1):88-95
55. Lumme P, Laatikainen LT. Risk factors for intraoperative and early postoperative complications in extracapsular cataract surgery. Eur J Ophthalmol 1994 Jul-Sep;4(3):151-8
56. Schroeder B. Sutureless Cataract Extraction: Complications, Management and Learning Curves. Community Eye Health 2003;16(48):58-60.
2.. Murthy GVS, Gupta SK, Bachani D, Jose R, John N. Current estimates of blindness in India. Br J Ophthalmol 2005;89:257-60
3. Jose R, Bachani D. World bank assisted cataract blindness controle project. Indian J Ophthalmol 1995;43:35-43
4. National Programme for Control of Blindness, India. Performance of cataract surgery between April2002 and March 2003, National Programme for Control of Blindness-India, Quarterly Newsletter 2003;2:2.
5. National Programme for Control of Blindness,India. Revised pattern of assistance under NPCB, National Programme for Control of BlindnessIndia, Quarterly Newsletter 2004;3:2
6. Dandona L, Dandona R, Naduvilath TJ, McCarty CA, Mandal P, Srinivas M, et al. Population based assessment of the outcome of cataract surgery in an urban population of southern India. Am J Ophthalmol 1999;127:650-658.
7. Limburg H, Foster A, Vaidyanathan K, GVS Murthy. Monitoring visual outcome of cataract surgery in India. Bull WHO, 1999;77:455–460.
8. Fletcher AE, Donoghue M, Devavaram J, Thulasiraj RD, Scott S, Abdalla M, et al. Low uptake of eye services in rural India: A challenge for programs of blindness prevention. Arch Ophthalmol. 1999;117:1393–1399
9. Vaidyanathan K, Limburg H, Foster A, Pandey RM. Changing trends in barriers to cataract surgery in India. Bull WHO. 1999;77:104–109
10. World Health Organization. Informal consultation on analysis of blindnessprevention outcomes, Geneva, WHO/PBL/98.68.
11. Yorston D, Gichuhi S, Wood M, Foster A. Does prospective monitoring improvecataract surgery outcomes in Africa? Br J Ophthalmol 2002;86:543–7
12. Lundstrom M, Barry P, Leite E, et al. 1998 European Cataract Outcome Study:report from the European Cataract Outcome Study Group. J Cataract RefractSurg 2001; 27:1176–84.
13. Manual of ‘MONITORING CATARACT SURGICAL OUTCOME (MCSO) for Windows (version 2.4 –November 2009),: A data entry and analysis package for monitoring and evaluation of visual outcome of cataract surgery for IBM compatible microcomputers 2009:2-3
14. Snell RS, Lemp MA. Clinical anatomy of the eye, 2nd ed., Boston: BlackwellScience Inc., 1998; 197-204.
15. Bron AJ, Tripathi RC, Tripathi BJ. Wolff’s Anatomy of the Eye and Orbit. 8th ed., London, Chapman & Hall; 1997: 411-442.
16. Tamm E, Flugel C, Stefani FH, Rohen JW: Contractile cells in the human scleral spur. Exp Eye Res, 1992 54:531
17. Gullstrand A: Einführung in die Methoden der Dioptrik des Auges des Menschen. Leipzig, S HirzelVerlag, 1911:4-5
18. Smith P: Diseases of the crystalline lens and capsule. Trans OphthalmolSoc UK 1883: 3:79,
19. Heine L: Physiologisch-anatomische Untersuchungenüber die Accomodation des Vogelauges. Albrecht Von Graefes Arch Ophthalmol 45:469, 1898
20. Scammon R, Hesdorffer M: Growth in mass and volume of human lens in postnatal life. Arch Ophthalmol,1937: 17:104,
21. A K Khurana, InduKhurana. Anatomy & physiology ofeye, second edition, CBS publishers & distributers pvt. Ltd.2006: 85-126
22. Patterson CA, Delamere NA. The Lens In: Hart WM Eds. Adler’s Physiologyof the Eye. 9th Ed. St. Louis: Mosby, 1992: 348-383
23. Reddy, D.V.N.: Transport of organic molecules in the lens. Exp. Eye Res. 1973; 15 : 731-750.
24. Torkel,S. : The physical basis for transparency of the crystalline lens. Invest.Ophthalmol. 1962; 1: 493-501
25. Jones HA, LermanS : Optical rotatory dispersion and circular dichroism studies on ocular lens proteins. Can. J. Biochem. 1971; 49: 426-430.
26. James C Bobrow, Mark H Blecher, David B Glasser, Kenneth B Mitchell. Basic and clinical science course. Lens and Cataract. Chapter 8. In: Surgery for Cataract.San Francisco: American Academy of Ophthalmology; 2008-2009. pp. 91-100.
27. Basti S, VasavadaAR,Thomas R, Padmanabhan P. Extracapsular cataract extraction : Surgical techniques. Indian J ophathalmol 1993;41:195-210.
28. Shah AR, Vasavada AR. Extracapsular cataract extraction & IOL implantation. In : Dutta LC, editor. Modern Ophthalmology. 3rd edition. New Delhi. Jaypee Brothers Medical Publishers.2005 p 367-377.
29. Kamaljeet Singh, KS Kathait. History of Cataract surgery. Manual small incision cataract surgery ( manualphaco) 2nd edition 2010;2:4-8.
30. Emery J, Steinert RF. Extracapsular cataract surgery: indications & technique in :Steinert RF, editor.Cataract surgery: technique, complications & management. 2nd edition. Elsevier sciences(USA) 2004.p 97-107.
31. Kratz RP, Colward DM, Mazzacco TR et al. Clinical evaluation of terry surgical keratometer. Am intraocular implant soc 1980:6:249-51
32. Haldipurkar SS, Shikari HT, Gokhale V. Wound construction in manual small incision cataract surgery. Indian J Ophthalmol 2009;57:9-13.
33. Singer JA. Frown incision for minimizing surgically induced astigmatism after small incision cataract surgery with rigid optic intraocular lens implantation. J cataract refract surg 1991;17:677-88
34. Pallin SL. Chevron incision for cataract surgery. J cataract refract surg; 1990:16:779-81
35. Pallin SL. Chevron sutureless closure: A preliminary report. J cataract refract surg. 1991:17;706-9.
36. Venkatesh R, Das M, Prashanth S, Muralikrishnan R. Manual small incision cataract surgery in eyes with white cataract. Indian J ophthalmol. 2005;53:173-6
37. Agarwal A, Trivedi RH, Jacob S, Agarwal A, Agarwal S. Microphakonit: 700 micron cataract surgery. Clinical ophthalmology (Auckland, N.Z.) 2007;1(3):323-325.
38. Michal A Lawless MD ”The Future of Laser Cataract Surgery” Keynote Lecture “Refractive Surgery 2012 The Era of Lasers and Lenses” American Academy of Ophthalmology, Subspecialty Day, Chicago, November, 2012,120-122
39. Daniel F, Goodman DF, Walter J, Stack WJ, Goltsch JD. Complications ofcataract extraction with intraocular lens implantation. Ophthalmic Surgery,Feb. 1989; 20(2): 132-140.
40. Sihota R, Tandon R, Parson’s Diseases of the Eye, 21st edition, Elseivier publications 2011:18: 256-280
41. G P Pokharel, G Regmi, S K Shrestha, A D Negrel, L B Ellwein Prevalence of blindness and cataract surgery in Nepal Br J Ophthalmol1998;82:600–605
42. Anand R, Gupta A, Ram J, Singh U, Kumar R. Visual outcome following cataract surgery in rural punjab. Indian J Ophthalmol 2000;48:153
43. R A Bourne, B P Dineen, S M Ali, D M NoorulHuq, G J Johnson,Outcomes of cataract surgery in Bangladesh: results from a population based nationwide survey, Br J Ophthalmol 2003;87:813–819
44. P M Gogate, M Deshpande, R P Wormald, R Deshpande, S R Kulkarni Extracapsular cataract surgery compared with manual small incision cataract surgery in community eye care setting in western India: a randomised controlled trial.Br J Ophthalmol 2003;87:667–672
45. A R Malik, Z A Qazi, C Gilbert Visual outcome after high volume cataract surgery inPakistan Br J Ophthalmol 2003;87:937–940
46. Lindfield R, Polack S, Wadud Z, Choudhury KA, Rashid AK, Kuper H et al.‘Causes of poor outcome after cataract surgery in Satkhira district, Bangladesh:Eye
(Lond). 2008 Aug;22(8):1054-6.
47. H. C. Obiudu, B. I. Obi, O. C. Anyalebechi Monitoring Cataract Surgical Outcome in a Public Hospital in Orlu, South East Nigeria Niger Med J, 2009: 50:4-5
48. PipatKongsapSutureless large-incision manual cataract extraction using the kongsap technique: outcome of a prospective study int J Ophthalmol 2010; 3(3);241-244
49. Gogate P, VakilV, Khandekar R, Deshpande M, Limburg H Monitoring and modernization to improve visual outcomes of cataract surgery in a community eyecare center in western India.J Cataract Refract Surg. 2011 Feb;37(2):328-34.
50. Guirou N, Napo A, Dougnon A, Bakayoko S, Sidibé F, Sidibé MK, Conaré I, Traoré L, Traoré J.; Visual outcome of cataract surgery in adults’ ;Journal of Evolution of Medical and Dental Sciences 2014; Vol. 3, Issue 06, February 10;J Fr Ophtalmol. 2013 Jan;36(1):19-22. doi: 10.1016/j.jfo.2012.04.016. Epub 2012 Dec 5 Page: 1536-1541, DOI: 10.14260/jemds/2014/2020
51. ChanchlaniMadhu, Sarkar N, Manghani J, Soni B, Chanchlani R. “Evaluation of Visual Outcome after Cataract Surgery in Camp Patients - A Study from Central
India”.
52. Oladigbolu KK, Rafindadi AL, Mahmud-Ajeigbe AF, Chinda D, Pam V, Samaila E.Outcome of cataract surgery in rural areas of Kaduna State, Nigeria. Ann Afr Med 2014:13:25-9
53. Vashist P, Talwar B, Gogoi M, Maraini G, Camparini M. Prevalence of cataract in an older population in India: the India study of age-related eye disease. Ophthalmology. 2011 Feb;118(2):272-8.e12.doi:10.1016/j.ophtha.2010.05.020
54. Murthy GV, Gupta SK, Maraini G, Camparini M, Price GM, Dherani M et al.Prevalence of lens opacities in North India: the INDEYE feasibility study Invest Ophthalmol Vis Sci. 2007 Jan;48(1):88-95
55. Lumme P, Laatikainen LT. Risk factors for intraoperative and early postoperative complications in extracapsular cataract surgery. Eur J Ophthalmol 1994 Jul-Sep;4(3):151-8
56. Schroeder B. Sutureless Cataract Extraction: Complications, Management and Learning Curves. Community Eye Health 2003;16(48):58-60.
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Dr. Sudhir Sudhakar Pendke, Dr. Ravi Atmaram Chauhan, Dr. Sachin Omprakash Agrawal, Dr. Chaitali Nandkishor Bhavsar, Dr. Sanchit Satish Bhalgat. VISUAL OUTCOMES IN CATARACT SURGERY. Med. res. chronicles [Internet]. 2016Apr.30 [cited 2024Apr.29];3(02):214-31. Available from: https://medrech.com/index.php/medrech/article/view/170
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