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Patel V, Pakravan P, Lai J, Watane A, Mehra D, Eatz TA, Patel N, Yannuzzi NA, Sridhar J. Intraocular Lens Exchange: Indications, Comparative Outcomes by Technique, and Complications. Clin Ophthalmol 2023; 17:941-951. [PMID: 36993987 PMCID: PMC10041992 DOI: 10.2147/opth.s399857] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2022] [Accepted: 02/24/2023] [Indexed: 03/31/2023] Open
Abstract
Purpose To describe the indications, outcomes, and complications associated with intraocular lens (IOL) exchange. Patients and Methods To determine the relative frequency of postoperative complications between techniques for all patients undergoing IOL exchange from May 1, 2014 through August 31, 2020. Results IOL exchange was performed in 511 eyes of 489 patients (59.7% men; mean age: 67.0 ± 13.9 years, median time from cataract procedure to IOL exchange: 47.5 months). Mean uncorrected visual acuity significantly improved from 20/192 Snellen equivalent (logMAR 0.981) preoperatively to 20/61 (logMAR 0.487) at last follow-up (P < 0.001). Overall, 384 eyes (78.7%) met their desired refractive outcome within ±1.0 diopter (D). The most frequent complication was cystoid macular edema (CME) (n=39, 7.6%). Iris-sutured technique was associated with significantly greater frequency of subsequent IOL dislocation (10.3%) than 4-point scleral sutured (0%, P = 0.002), anterior chamber IOL (ACIOL, 1.5%, P = 0.01), and 2-point scleral sutured (0%, P = 0.03) techniques. Yamane scleral-fixation technique was associated with significantly greater frequency of developing IOL tilt (11.8%) than ACIOL (0%, P = 0.002), 4-point scleral sutured (1.1%, P = 0.01), 2-point scleral sutured (0%, P = 0.04), and iris-sutured (0%, P = 0.04) techniques. Conclusion IOL exchange significantly improved uncorrected visual acuity and more than three-quarters of eyes met the refractive goal. Certain techniques were associated with complications, including subsequent dislocation associated with iris-sutured technique and IOL tilt associated with Yamane scleral-fixation technique. This information may help guide surgeons in deciding between procedural techniques for individual patients during IOL exchange preoperative planning.
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Affiliation(s)
- Veshesh Patel
- Bascom Palmer Eye Institute at the University of Miami Miller School of Medicine, Miami, FL, USA
| | - Parastou Pakravan
- Bascom Palmer Eye Institute at the University of Miami Miller School of Medicine, Miami, FL, USA
| | - James Lai
- Bascom Palmer Eye Institute at the University of Miami Miller School of Medicine, Miami, FL, USA
| | - Arjun Watane
- Bascom Palmer Eye Institute at the University of Miami Miller School of Medicine, Miami, FL, USA
- Department of Ophthalmology and Visual Science, Yale School of Medicine, New Haven, CT, USA
| | - Divy Mehra
- Bascom Palmer Eye Institute at the University of Miami Miller School of Medicine, Miami, FL, USA
| | - Tiffany Alyssa Eatz
- Bascom Palmer Eye Institute at the University of Miami Miller School of Medicine, Miami, FL, USA
| | - Nimesh Patel
- Bascom Palmer Eye Institute at the University of Miami Miller School of Medicine, Miami, FL, USA
- Mass, Eye and Ear, Harvard Medical School, Boston, MA, USA
| | - Nicolas A Yannuzzi
- Bascom Palmer Eye Institute at the University of Miami Miller School of Medicine, Miami, FL, USA
| | - Jayanth Sridhar
- Bascom Palmer Eye Institute at the University of Miami Miller School of Medicine, Miami, FL, USA
- Correspondence: Jayanth Sridhar, Bascom Palmer Eye Institute at the University of Miami Miller School of Medicine, 900 NW 17th Street, Miami, FL, 33136, USA, Tel +1 305-326-6124, Fax +1 305-326-6417, Email
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Efficacy, safety and visual outcomes of cataract surgeries performed during blindness prevention programs in different locations in Kenya. Graefes Arch Clin Exp Ophthalmol 2021; 259:1215-1224. [PMID: 33512611 DOI: 10.1007/s00417-021-05084-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2020] [Revised: 01/03/2021] [Accepted: 01/15/2021] [Indexed: 10/22/2022] Open
Abstract
PURPOSE To determine the visual outcomes achieved in terms of efficacy and safety during high-volume cataract surgery programs in different locations in Kenya. METHODS Eight hundred eighty-one eyes of 849 patients underwent extracapsular cataract extraction with intraocular lens implantation in a retrospective, observational, consecutive cohort study on patients who underwent cataract surgery in five programs that a Spanish non-governmental organization conducted between 2013 and 2019 for the prevention of blindness in different geographical areas of Kenya: Thika, Athi River, Kissi, Bagavathi, and Nakuru. The programs were carried out by Spanish and Kenyan surgeons working together. RESULTS Mean age was 66.81 ± 14.47 years. Fifty-one percent of the operated eyes (447 eyes) were women. 94% of patients belonged to six ethnic groups. The mean uncorrected distance visual acuity (UDVA) before surgery was 1.98 ± 0.98 logMAR (20/2000), which changed to 0.82 ± 0.68 logMAR (20/150) 3 months after surgeries. The corrected distance visual acuity (CDVA) was 0.4 ± 0.53 logMAR (20/50) 3 months after surgery, 77.5% of the patients had good visual outcomes, and 6.3% had poor outcomes. Preoperative UDVAs were significantly different with respect to the different geographical areas (Kruskal-Wallis; p < 0.001). The most common intraoperative complication was posterior capsule rupture (incidence, 4.2%, 37 of 881), and the most serious complication was expulsive hemorrhage (incidence, 0.1%, 1 of 881). CONCLUSIONS Cataract programs performed in a middle-income country with the proper technique and standardized protocols of action improved the visual outcome of the patients. Dissimilar baseline status was found in different areas regarding preoperative visual acuities. Training programs of local surgeons should be reinforced.
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Javaloy J, Signes-Soler I, Moya T, Litila S. Cataract surgery in surgical camps: outcomes in a rural area of Cameroon. Int Ophthalmol 2020; 41:283-292. [PMID: 32979111 DOI: 10.1007/s10792-020-01580-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2020] [Accepted: 08/29/2020] [Indexed: 11/29/2022]
Abstract
AIM To assess the complications and visual outcomes of cataract surgery during an outreach eye camp in Cameroon in which two foreign ophthalmologists operate alongside a local one. MATERIALS AND METHODS This is a retrospective and comparative cohort study. The patients were consecutively assigned to three groups depending on the ophthalmologist who performed the cataract surgeries. All eyes underwent manual sutureless incision cataract surgery with posterior chamber intraocular lens (PCIOL) implantation under peribulbar anesthesia. Postoperative visits were scheduled for the first day, first week and second month after the procedures. Intra- and postoperative complications, best-corrected visual acuity and also refractive errors were assessed. RESULTS A total of 263 eyes underwent cataract extraction with PCIOL implantation. The percentage of eyes in which two or more lines of corrected distance visual acuity decreased were 2.4%, 2.7% and 0% for groups A, B and C, respectively. The percentage of eyes with good visual outcome (uncorrected distance visual acuity UDVA > 20/60) were, respectively, 82.09%, 81.43% and 80.82% for the three groups. Similar results were found between the three groups regarding complications. Ocular hypertension, transient corneal edema and hyphema were the incidences registered at the first postoperative control performed 24 h after surgery. The most common complication observed 2 months after surgery was posterior capsular opacity (2.6%). CONCLUSION High-volume cataract surgery in low- and middle-income countries may have good visual outcomes and a low rate of complications when the procedures are performed by either foreign or local ophthalmologists. SYNOPSIS A program of high-volume cataract surgery carried out in a rural environment with few resources can give good visual outcomes in the hands of both foreign and local experienced ophthalmologists.
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Affiliation(s)
- Jaime Javaloy
- Clínica Baviera, Alicante, Spain.,Vision Without Borders, Calle Corbeta nº 6, 03710, Calpe, Alicante, Spain
| | - Isabel Signes-Soler
- Vision Without Borders, Calle Corbeta nº 6, 03710, Calpe, Alicante, Spain. .,Department of Optics and Optometry and Visual Sciences, University of Valencia, Valencia, Spain.
| | - Tomás Moya
- Vision Without Borders, Calle Corbeta nº 6, 03710, Calpe, Alicante, Spain.,Clínica Baviera, Valencia, Spain
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Psychometric Properties of the Vietnamese Catquest-9 Short Form Questionnaire. Optom Vis Sci 2020; 97:192-197. [DOI: 10.1097/opx.0000000000001493] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
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Zhao J, Yu J, Wang T, Mban B. Ciliary sulcus implantation of intraocular lens in manual small incision cataract surgery complicated by large posterior capsule rupture. Exp Ther Med 2018; 17:1470-1475. [PMID: 30680030 DOI: 10.3892/etm.2018.7074] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2015] [Accepted: 01/08/2018] [Indexed: 01/03/2023] Open
Abstract
The present study aimed to evaluate the safety and efficiency of ciliary sulcus implantation of intraocular lens (IOL) in patients that had undergone manual small incision cataract surgery (MSICS) complicated by large posterior capsule rupture (LPCR). A total of 11 eyes taken from 11 patients in Brazzaville, Republic of the Congo, that had experienced LPCR following MSICS were included in the current study. A rigid single-piece IOL (5.5 mm optic, 12.50 mm overall length) was implanted into the ciliary sulcus. Postoperative follow-up assessments evaluated visual acuity, anterior segment biomicroscopy, IOL centration and position, and fundus biomicroscopy. The median follow-up time was 3.7 months (range, 2-6 months). All patients experienced vision improvement: Uncorrected visual acuity 2 months following surgery was 0.3-0.5 in 9 patients and >0.5 in 2 patients. Postoperative complications included pronounced anterior segment inflammation (1 patient), mild corneal endothelium edema (3 patients), residual cortex (1 patient) and intraocular pressure elevation (1 patient). Significant IOL decentration and tilt were not observed in any patients. The results of the present study indicate that ciliary sulcus implantation of a rigid single-piece IOL may be a feasible and effective method of treating patients that have experienced LPCR complications following cataract surgery, as it provides satisfactory visual acuity outcomes. Appropriate intraoperative management may reduce the incidence of postoperative complications.
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Affiliation(s)
- Jinrong Zhao
- Department of Refractive Surgery Centre, Tianjin Eye Hospital, Tianjin 300121, P.R. China
| | - Jinguo Yu
- Department of Ophthalmology, Tianjin Medical University General Hospital, Tianjin 300052, P.R. China
| | - Tiecheng Wang
- Department of Cataract, Tianjin Medical University Eye Hospital and The College of Optometry and Ophthalmology, Tianjin 300384, P.R. China
| | - Bertin Mban
- Department of Ophthalmology, Sino-Congo Friendship Hospital, Brazzaville B.P. 869, Republic of the Congo
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Fortané M, Bensaid P, Resnikoff S, Seini K, Landreau N, Paugam JM, Nagot N, Mura T, Serrand C, Villain M, Daien V. Outcomes of cataract surgery performed by non-physician cataract surgeons in remote North Cameroon. Br J Ophthalmol 2018; 103:1042-1047. [PMID: 30291137 DOI: 10.1136/bjophthalmol-2018-312428] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2018] [Revised: 07/12/2018] [Accepted: 08/28/2018] [Indexed: 11/04/2022]
Abstract
OBJECTIVE To report the outcomes of cataract surgery performed by non-physician cataract surgeons due to lack of ophthalmologists in remote areas of North Cameroon. DESIGN Prospective cohort study. SETTING The main centre of the non-governmental organisation Ophtalmo Sans Frontières in Lagdo. PARTICIPANTS AND INTERVENTIONS Age-related cataract surgery performed between 28 November 2016 and 17 May 2017. MAIN OUTCOMES MEASURES The main outcome measure was presenting visual acuity (PVA) 1-4 weeks after surgery, classified according to the WHO as good (PVA ≥6/18), borderline (PVA 6/60-6/18) and poor (PVA <6/60). The WHO definition of blindness (visual acuity <3/60) and severe visual acuity (visual acuity 3/60-6/60) was used to assess the proportion of patients with a change in WHO category. RESULTS We included 474 eyes of 474 patients; the mean (SD) age was 63.9 (15) years (42.2% female). At 1-4 weeks after surgery, the surgical outcome was good for 170 patients (41.1%), borderline for 213 (51.5%) and poor for 31 (7.5%). In all, 224 patients (47.2%) had blindness or severe visual impairment before cataract surgery and 22 (5.3%) at 1-4 weeks after surgery. Poor visual outcome was associated with older age (p=0.018), preoperative blindness or severe impairment (p=0.012) and surgical complications (p=0.019). CONCLUSION Blindness and severe visual impairment were significantly decreased in the early postoperative period. Poor outcomes were associated with older age, low preoperative binocular visual acuity and intraoperative complications. Non-physician cataract surgeons may compensate for the lack of ophthalmologists in remote areas of low-income and middle-income countries.
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Affiliation(s)
- Magali Fortané
- Department of Ophthalmology, Gui De Chauliac Hospital, Montpellier, France
| | | | - Serge Resnikoff
- Brien Holden Vision Institute, University of New South Wales, Sydney, New South Wales, Australia.,Organisation Pour la prévention de la Cécité (OPC), Paris, France
| | - Kali Seini
- Ophtalmo Sans Frontières, Lagdo, Cameroon
| | | | | | - Nicolas Nagot
- Department of Medical Information, La Colombière Hospital, Montpellier, France
| | - Thibault Mura
- Department of Medical Information, La Colombière Hospital, Montpellier, France.,INSERM (Institut National de la Santé Et de la Recherche Médicale), Montpellier, France
| | - Chris Serrand
- Department of Medical Information, La Colombière Hospital, Montpellier, France
| | - Max Villain
- Department of Ophthalmology, Gui De Chauliac Hospital, Montpellier, France
| | - Vincent Daien
- Department of Ophthalmology, Gui De Chauliac Hospital, Montpellier, France .,INSERM (Institut National de la Santé Et de la Recherche Médicale), Montpellier, France.,The Save Sight Institute, Sydney Medical School, The University of Sydney, Sydney, New South Wales, Australia
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Giles K, Robert ES, Come EM, Wiedemann P. Simultaneous Bilateral Cataract Surgery in Outreach Surgical Camps. OPHTHALMOLOGY AND EYE DISEASES 2017; 9:1179172117701738. [PMID: 28469481 PMCID: PMC5404900 DOI: 10.1177/1179172117701738] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/05/2017] [Accepted: 03/02/2017] [Indexed: 11/28/2022]
Abstract
OBJECTIVES The aim of this study was to evaluate the safety and visual outcomes of simultaneous bilateral cataract surgery (SBCS) with intraocular lens implantation performed in outreach surgical eye camps. METHODS The medical records of 47 consecutive patients who underwent simultaneous bilateral small-incision cataract surgery between January 2010 and December 2015 in outreach surgical camps in rural Cameroon were reviewed. The measures included postoperative visual outcomes and intraoperative and postoperative complications. RESULTS Data from 94 eyes of 47 participants (30 men, 17 women; mean age: 60.93 ± 13.58 years, range: 45–80 years) were included in this study. The presented best visual acuity (VA) was less than 3/60 in 100% of the eyes. At the 4-week follow-up, 84.04% of the eyes showed increased VA of 1 line or more (P = .001). Of these, 71 (75.53%) achieved good VA (greater than 6/18). Intraoperative or postoperative complications occurred in 19 (20.21%) eyes. The most serious intraoperative complication was a posterior capsule rupture and vitreous loss (2 patients, 2 eyes). The postoperative complications included a transient elevation in the intraocular pressure (6 eyes), chronic corneal oedema (5 eyes), iris capture (3 eyes), lens decentration (2 eyes), and hyphema (1 eye). No cases of postoperative endophthalmitis were recorded. CONCLUSIONS Under the strict observation of endophthalmitis prophylaxis, SBCS is an option to reduce the cataract blindness backlog in rural areas of developing countries.
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Affiliation(s)
- Kagmeni Giles
- University Teaching Hospital of Yaounde (UTHY), Yaoundé, Cameroon.,Faculty of Medicine and Biomedical Sciences, University of Yaoundé I, Yaoundé, Cameroon.,Eye Department, University Yaoundé I, Yaoundé, Cameroon
| | - Ebana Steve Robert
- University Teaching Hospital of Yaounde (UTHY), Yaoundé, Cameroon.,Faculty of Medicine and Biomedical Sciences, University of Yaoundé I, Yaoundé, Cameroon
| | - Ebana Mvogo Come
- Faculty of Medicine and Biomedical Sciences, University of Yaoundé I, Yaoundé, Cameroon.,Central Hospital of Yaoundé, Yaoundé, Cameroon
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Signes-Soler I, Javaloy J, Muñoz G, Moya T, Montalbán R, Albarrán C. Safety and Efficacy of the Transition from Extracapsular Cataract Extraction to Manual Small Incision Cataract Surgery in Prevention of Blindness Campaigns. Middle East Afr J Ophthalmol 2017; 23:187-94. [PMID: 27162451 PMCID: PMC4845617 DOI: 10.4103/0974-9233.175890] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
PURPOSE To compare the safety and the visual outcomes of two experienced cataract surgeons who converted from extracapsular cataract extraction (ECCE) to manual small incision cataract surgery (MSICS) during a campaign for the prevention of blindness. METHODS Two surgeons used the ECCE technique (ECCE group) during a campaign in Burkina Faso on 93 consecutive cataract patients with a corrected distance visual acuity (CDVA) <20/80 in the best eye. Both surgeons used MSICS for the first time on 98 consecutive cases in another campaign in Kenya after theoretical instructional courses. RESULTS There were no significant differences in CDVA at 3 months postoperatively. There were 69% of eyes with uncorrected distance visual acuity ≥20/60 in the MSICS group and 49% eyes in the ECCE group. Spherical equivalents ranged between -1D and +1D in 55% of the MSICS group versus 43% in the ECCE group. There were significant differences in the changes in the vertical component of astigmatism (J45) but not the horizontal (J0) component. There were no significant differences in the intraoperative complications. The most common postoperative complication was corneal edema on the first day in 40.86% and 19.38% of the ECCE and MSICS groups, respectively. CONCLUSION Transitioning from ECCE to MSICS for experienced cataract surgeons in surgical campaigns is safe. The rate of complications is similar for both techniques. Slightly better visual and refractive outcomes can be achieved due to the decreased induction of corneal astigmatism.
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Affiliation(s)
| | | | - Gonzalo Muñoz
- Centro Oftalmológico Marqués de Sotelo, Valencia, Spain
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Matta S, Park J, Palamaner Subash Shantha G, Khanna RC, Rao GN. Cataract Surgery Visual Outcomes and Associated Risk Factors in Secondary Level Eye Care Centers of L V Prasad Eye Institute, India. PLoS One 2016; 11:e0144853. [PMID: 26741363 PMCID: PMC4711773 DOI: 10.1371/journal.pone.0144853] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2015] [Accepted: 11/24/2015] [Indexed: 11/18/2022] Open
Abstract
PURPOSE To evaluate cataract surgery visual outcomes and associated risk factors in rural secondary level eye care centers of L V Prasad Eye Institute (LVPEI), India. METHODS The Eye Health pyramid of LVPEI has a network of rural secondary care centres (SCs) and attached vision centres (VCs) that provide high quality comprehensive eye care with permanent infrastructure to the most disadvantaged sections of society. The most common procedure performed at SCs is cataract surgery. We audited the outcome of a random sample of 2,049 cataract surgeries done from October 2009-March 2010 at eight rural SCs. All patients received a comprehensive ophthalmic examination, both before and after surgery. The World Health Organization recommended cataract surgical record was used for data entry. Visual outcomes were measured at discharge, 1-3 weeks and 4-11 weeks follow up visits. Poor outcome was defined as best corrected visual acuity <6/18. RESULTS Mean age was 61.8 years (SD: 8.9 years) and 1,133 (55.3%) surgeries were performed on female patients. Pre-existing ocular co-morbidity was present in 165 patients (8.1%). The most common procedure was small incision cataract surgery (SICS) with intraocular lens (IOL) implantation (91.8%). Intraoperative complications were seen in 29 eyes (1.4%). At the 4-11 weeks follow-up visit, based on presenting visual acuity (PVA), 61.8% had a good outcome and based on best-corrected visual acuity (BCVA), 91.7% had a good outcome. Based on PVA and BCVA, those with less than 6/60 were only 2.9% and 1.6% respectively. Using multivariable analysis, poor visual outcomes were significantly higher in patients aged ≥70 (OR 4.63; 95% CI 1.61, 13.30), in females (OR 1.58; 95% CI 1.04, 2.41), those with preoperative comorbidities (odds ratio 4.68; 95% CI 2.90, 7.57), with intraoperative complications (OR 8.01; 95% CI 2.91, 22.04), eyes that underwent no IOL or anterior chamber-IOL (OR 12.63; 95% CI 2.65, 60.25) and those undergoing extracapsular cataract extraction (OR 9.39; 95% CI 1.18, 74.78). CONCLUSIONS This study demonstrates that quality cataract surgeries can be achieved at rural SCs. The concept of the LVPEI SCs can be applied to other developing countries, allowing rural patients to attain better vision through cataract surgery. Despite improvements in quality of cataract surgery, gender discrimination in terms of outcome continues to be an issue and needs further investigation.
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Affiliation(s)
- Sumathi Matta
- Andhra Pradesh Right to Sight Society, Hyderabad, India
| | - Jiwon Park
- Massachusetts Institute of Technology, Cambridge, United States of America
| | | | - Rohit C Khanna
- Allen Foster Research Centre for Community Eye Health, Gullapalli Pratibha Rao International Centre for Advancement of Rural Eye care, L V Prasad Eye Institute, Hyderabad, India.,Brien Holden Eye Research Centre, L.V. Prasad Eye Institute, Banjara Hills, Hyderabad, India
| | - Gullapalli N Rao
- Allen Foster Research Centre for Community Eye Health, Gullapalli Pratibha Rao International Centre for Advancement of Rural Eye care, L V Prasad Eye Institute, Hyderabad, India.,Brien Holden Eye Research Centre, L.V. Prasad Eye Institute, Banjara Hills, Hyderabad, India
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