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Govinda Raju D, Ramli N, Salowi MA. Incidence and Predictive Risk Factors for Post-Cataract Surgery Endophthalmitis in Ministry of Health Hospitals from 2012 to 2020. Ophthalmic Epidemiol 2024; 31:342-348. [PMID: 37899640 DOI: 10.1080/09286586.2023.2273504] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2023] [Accepted: 10/17/2023] [Indexed: 10/31/2023]
Abstract
PURPOSE Postoperative endophthalmitis is a devastating complication, leading to poor visual prognosis. The purpose of this study is to determine the incidence, risk factors, and visual outcome of post-cataract surgery endophthalmitis in Malaysia over a 9-year period (2012-2020). METHODS Data from National Eye Database (NED), involving all patients who have undergone cataract surgery from January 2012 until December 2020 were analyzed. RESULTS Total number of patients who had undergone cataract surgery between the year 2012 till 2020 were 231,281 patients (267,781 eyes). Incidence of POE in this population was 0.08%. Patient aged 70 and above (p-value 0.047), Malay ethnicity (p-value: 0.009), presence of ischemic heart disease, renal failure, diabetic retinopathy, and poorer preoperative vision were shown to have a higher risk of POE. Cataract surgeries done in KK-KKM, duration more than 45 minutes, use of general anaesthesia, and no IOL or ACIOL implantation were significantly more in POE patients. Multivariate analysis revealed Malay ethnicity, presence of ocular comorbidity, poor preoperative vision, ACIOL, and presence of intra-operative complication were predictive factors for POE. CONCLUSIONS Incidence of POE is low in the Malaysian population. Surgeons have to be aware that Malay ethnicity, presence of ocular comorbidity, poor preoperative visual acuity, placement of IOL and complicated cataract operation have higher risk of POE.
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Affiliation(s)
- Durgavashini Govinda Raju
- Department of Ophthalmology, Faculty of Medicine, Universiti Malaya, University of Malaya Eye Research Centre (UMERC), Kuala Lumpur, Malaysia
| | - Norlina Ramli
- Department of Ophthalmology, Faculty of Medicine, Universiti Malaya, University of Malaya Eye Research Centre (UMERC), Kuala Lumpur, Malaysia
| | - Mohamad Aziz Salowi
- Department of Ophthalmology, Hospital Selayang, Batu Caves, Selangor, Malaysia
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Andini EA, Avianty A, Herman H, Choliq A. Efficacy and Safety of Manual Small-Incision Cataract Surgery With Trabeculectomy Versus Phacotrabeculectomy in Patients With Glaucoma and Cataract: A Systematic Review and Meta-Analysis. Cureus 2023; 15:e51025. [PMID: 38264398 PMCID: PMC10804908 DOI: 10.7759/cureus.51025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/24/2023] [Indexed: 01/25/2024] Open
Abstract
The coexistence of two globally leading causes of blindness, glaucoma and cataracts, is common. Combining trabeculectomy with cataract surgery is a common practice while determining the preferred surgical management for patients is a complex consideration. Therefore, a systematic review and meta-analysis were conducted to compare the efficacy and safety of two surgical procedures, manual small-incision cataract surgery (MSICS) combined with trabeculectomy and phacotrabeculectomy. A comprehensive search was performed in PubMed, Science Direct, and Cochrane Library published up to March 2023. Articles not indexed in those databases were also searched. Pooled odds ratios (OR) and mean differences (MD) with corresponding 95% confidence interval (CI) were also retrieved to compare the outcomes estimating efficacy and safety. Biases in selected studies were assessed. A total of seven studies consisting of 352 eyes for MSICS with trabeculectomy and 348 eyes for phacotrabeculectomy were included. Postoperative intraocular pressure (IOP) was comparable between the two techniques (MD: -0.45; 95% CI: -1.07 to 0.16; p = 0.15). Postoperative best corrected visual acuity (BCVA) <6/12 (OR: 1.26; 95% CI: 0.62 to 2.53; p = 0.52), complete success (OR: 0.92; 95% CI: 0.51 to 1.67; p = 0.78), and postoperative complications (OR: 1.27; 95% CI: 0.75 to 2.15, p = 0.38) did not differ significantly. This meta-analysis indicated comparable efficacy and safety profile between MSICS with trabeculectomy and phacotrabeculectomy. Further high-quality studies are required to confirm these findings.
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Affiliation(s)
- El A Andini
- Ophthalmology, Gunung Jati Regional General Hospital, Cirebon, IDN
| | - Astri Avianty
- Ophthalmology, Gunung Jati Regional General Hospital, Cirebon, IDN
| | - Herman Herman
- Ophthalmology, Gunung Jati Regional General Hospital, Cirebon, IDN
| | - Abdul Choliq
- Ophthalmology, Gunung Jati Regional General Hospital, Cirebon, IDN
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3
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Mohammed J, Assegid S, Fekadu L, Kabeta T. Cataract Surgery Visual Outcome and Associated Factors Among Adults Attended Jimma University Medical Center, Jimma, Southwest Ethiopia. Clin Ophthalmol 2023; 17:3341-3351. [PMID: 37941776 PMCID: PMC10629348 DOI: 10.2147/opth.s434453] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2023] [Accepted: 10/24/2023] [Indexed: 11/10/2023] Open
Abstract
Background Cataract is the leading cause of blindness and the second leading cause of visual impairment worldwide, accounting for 51% and 33% of all cases, respectively, in low- and medium-income countries bearing a disproportionately high burden. Hence, this study aimed to assess the visual outcome of age-related cataract surgery and identify factors associated with patients' postoperative visual outcomes in Jimma University Medical Center, Southwest Ethiopia. Methods An institution-based cross-sectional study design was conducted among 386 cataract surgery patients from January 1, 2016, to December 30, 2017. The study participants were selected using a systematic random sampling technique. Data were collected by reviewing the selected patients' medical records using a pre-tested checklist, entered into EpiData version 3.1, and exported to SPSS 20 for analysis. Proportions, summary statistics, and tables were used for presentations of the findings. Binary logistic regression was carried out to identify independent predictors of visual outcome. Findings were presented with adjusted odds ratios and their 95% confidence interval. A p-value <0.05 was used to declare a statistically significant association. Results About 231 individuals (59.8%) had poor visual results following cataract surgery. Furthermore, age >70 (AOR = 3.64; 95% CI [1.35-9.82]), preoperative ocular co-morbidities (AOR = 2.34; [1.32-4.15]), incision-based cataract surgery (AOR = 7.11; [3.16-16.02]), compared phacoemulsification operated by resident surgeons (AOR = 2.19; [1.23-3.89]), presence of intraoperative complication (AOR = 3.41; [1.47-7.92]), lens remnant (AOR = 2.91; [1.11-4.92]), ocular inflammation (OR = 2.56; [1.34-4.92]), and striate keratopathy/corneal edema (AOR = 1.91; [1.07-3.44]) were significantly associated with poor visual outcome. Conclusion The visual outcome following cataract surgery fall below WHO recommendation. In this study, age, ocular co-morbidities, surgical method, surgeon status, intraoperative complication, SK, and ocular inflammation associated with post-operative Uveitis and anterior chamber reaction were associated with a poor visual outcome.
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Affiliation(s)
- Jemmal Mohammed
- Department of Ophthalmology, Faculty of Medical Science, Institute of Health, Jimma University, Jimma, Ethiopia
| | - Sahilu Assegid
- Department of Epidemiology, Faculty of Public Health, Institute of Health, Jimma University, Jimma, Ethiopia
| | - Lata Fekadu
- Department of Epidemiology, Faculty of Public Health, Institute of Health, Jimma University, Jimma, Ethiopia
| | - Teshome Kabeta
- Department of Epidemiology, Faculty of Public Health, Institute of Health, Jimma University, Jimma, Ethiopia
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4
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Gogate P, Kulkarni AN. Comparative study of anatomical and functional recovery of eye along with patient satisfaction score after small-incision cataract surgery and phacoemulsification cataract surgery. Indian J Ophthalmol 2023; 71:3265-3266. [PMID: 37602624 PMCID: PMC10565938 DOI: 10.4103/ijo.ijo_3327_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/22/2023] Open
Affiliation(s)
- Parikshit Gogate
- Community Eye Care Foundation, Dr. Gogate’s Eye Clinic, Pune, Maharashtra, India
- Department of Ophthalmology, D.Y. Patil Medical College, Pimpri, Pune, Maharashtra, India
- School of Health Sciences, Queens University, Belfast, UK
- Atharva Netralaya and Research Pvt. Ltd, Pune, Maharashtra, India
| | - Anil N Kulkarni
- Atharva Netralaya and Research Pvt. Ltd, Pune, Maharashtra, India
- Dr. Kulkarni Eye Hospital, Miraj, Sangli, Maharashtra, India
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5
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Ifantides C, SooHoo JR, Christopher KL. Impact of a formal manual small-incision cataract surgery curriculum in an American ophthalmology residency program. Indian J Ophthalmol 2023; 71:2474-2477. [PMID: 37322664 PMCID: PMC10417980 DOI: 10.4103/ijo.ijo_1339_22] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2022] [Revised: 09/02/2022] [Accepted: 10/20/2022] [Indexed: 06/17/2023] Open
Abstract
Purpose Global ophthalmology educational activities often include the ability of ophthalmology residents to partake in low-resource clinical care at home and abroad. Low-resource surgical techniques have become a pillar of education during formalized global ophthalmology fellowships. A formal manual small-incision cataract surgery (MSICS) curriculum was started in the University of Colorado's residency training program to meet the growing demand for this surgical skill and to allow for more sustainable outreach work from our graduates. The survey was conducted to collect evaluations on the value of formal MSICS training within a United States-based residency program. Methods This was a survey study in a US ophthalmology residency program. A formal MSICS curriculum was created that included didactic lectures on epidemiology of global blindness, MSICS technique, and how MISCS compared to phacoemulsification in terms of cost and sustainability in low-resource settings, followed by a formal wet lab experience. Residents were then exposed to MSICS procedures in the operating room (OR) under supervision of an experienced MSICS surgeon. An anonymous online survey was conducted on three consecutive cohorts of recently graduated senior ophthalmology residents from 2019 to 2021 with the aim of eliciting opinions about and outcomes from the new curriculum. Results Fifteen graduating senior residents comprised the three cohorts with a 100% survey response rate. All residents agreed or strongly agreed that "MSICS is a valuable skill to have". Eighty percent of respondents agreed or strongly agreed that "exposure to MSICS has increased my likelihood of doing any type of outreach work in the future" and 86.67% agreed or strongly agreed that "exposure to MSICS increased my understanding about sustainable outreach work". The average number of cases assisted or performed per resident was 8.2 (SD 2.7, range 4-12). Conclusion A formal MSICS curriculum for US-based ophthalmology residents was well-received by the trainees. The majority felt it increased their likelihood of pursuing and improved their understanding of sustainable outreach work. The curriculum, which included lectures, wet lab training, and formal teaching in the OR, could add value to a residency program's curriculum. Furthermore, a formal domestic program can avoid ethical pitfalls that can be seen with resident teaching during international mission work.
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Affiliation(s)
- Cristos Ifantides
- Department of Surgery, Denver Health Medical Center, Denver, CO, USA
| | - Jeffrey R SooHoo
- Department of Ophthalmology, University of Colorado, Aurora, CO, USA
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Jha R, Priya B, Solu T, Patel I. Visual outcome and complications of small-incision cataract surgery. Oman J Ophthalmol 2023; 16:51-54. [PMID: 37007243 PMCID: PMC10062067 DOI: 10.4103/ojo.ojo_172_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2021] [Revised: 06/24/2022] [Accepted: 08/26/2022] [Indexed: 02/23/2023] Open
Abstract
BACKGROUND AND OBJECTIVES Small-incision cataract surgery (SICS) is a commonly performed procedure in developing countries. It does not require expensive machines and can be safely done in high-volume centers also yielding good visual outcomes in the majority of patients. The objective of our study was to assess visual outcomes after SICS conducted at a tertiary care center in South Gujarat and also assessment of various complications responsible for poor visual outcomes. MATERIALS AND METHODS Three hundred and fifteen cataract patients were included in the study. An assessment of intraoperative and postoperative complications was done. Postoperative visual acuity assessment was done and compared with preoperative visual acuity of the patient and factors responsible for poor visual outcomes were assessed. A follow-up examination was done on days 1, 3, 7, 14, and 30. RESULTS The mean age group of patients was 59.3 years. Females were slightly more (53.3%) in number as compared to males. The most common surgical complication encountered were striate keratopathy (6.35%), followed by iris damage (5.71%), posterior capsular rent (PCR) with vitreous loss (3.14%), hypotony (0.63%), intraocular lens decentration (0.63%), surgery-induced astigmatism (0.63%), choroidal detachment (0.32%), endophthalmitis (0.32%), and hyphema (0.32%). About 95.87% of patients had vision better than 6/18. Complications associated with poor visual outcome (<6/18) were PCR, endophthalmitis, choroidal detachment, and surgical-induced astigmatism. CONCLUSIONS Although SICS can have a significant chance of complications, good visual outcomes can be attained in the majority of patients.
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7
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Boramani J, Bali J, Boramani P, Bali O. Endoexpression technique of nucleus delivery in manual small-incision cataract surgery. Indian J Ophthalmol 2022; 70:4060-4062. [PMID: 36308159 PMCID: PMC9907317 DOI: 10.4103/ijo.ijo_1606_22] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Manual small-incision cataract surgery (MSICS) is a cost-effective alternative to phacoemulsification and extracapsular cataract extraction (ECCE) for cataract surgery. The surgical technique in MSICS is heterogeneous, and the maximum variation exists in incision and nucleus delivery techniques. Many studies on various incisions are available, and most of them are dedicated to surgically induced astigmatism (SIA), utility, and visual outcomes. The nucleus delivery techniques have less-extensive literature available. They can be divided into "pulling" techniques like phacosandwich technique, fish hook technique, and vectis delivery and "pushing" techniques like viscoexpression or hydroexpression with irrigating vectis/Blumenthal's MiniNuc technique. Postoperative surgical-induced astigmatism is comparable in all techniques. The authors describe a pushing technique which does not raise the pressure of the anterior chamber and can be utilized with variable-sized and irregularly shaped nuclear fragments. It has universal application, especially when the size of the incision is getting smaller in MSICS and phacofragmentation is being used as an adjunct to reduce the incision size. It can be used in situations like posterior polar cataracts, where pressure variations in the anterior chamber can be dangerous.
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Affiliation(s)
- Jagannath Boramani
- Department of Ophthalmology, Surya Netralaya, Vashi, Navi Mumbai, Maharashtra, India,Department of Ophthalmology, MGM’s New Bombay Hospital, Vashi, Navi Mumbai, Maharashtra, India
| | - Jatinder Bali
- Narela Polyclinic, North Delhi Municipal Corporation Delhi, India,Correspondence to: Dr. Jatinder Bali, 55-D, Third Floor, DDA Flats, Kalidas Road, Gulabibagh, Delhi – 110 007, India. E-mail:
| | - Priyanka Boramani
- Department of Ophthalmology, Surya Netralaya, Vashi, Navi Mumbai, Maharashtra, India
| | - Ojasvini Bali
- Department of Medicine, Maulana Azad Medical College, Delhi, India
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8
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Sahu A. Future scenario in cataract surgery. Indian J Ophthalmol 2022; 70:3749-3750. [PMID: 36308085 PMCID: PMC9907263 DOI: 10.4103/ijo.ijo_2167_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Affiliation(s)
- Amulya Sahu
- Founder Chairman, Kamal Netralaya, Mumbai, Founder Chairman, ISMSICS, Maharashtra, India. E-mail:
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9
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Honavar SG. Man vs machine - The future of manual small-incision cataract surgery. Indian J Ophthalmol 2022; 70:3747-3748. [PMID: 36308084 PMCID: PMC9907270 DOI: 10.4103/ijo.ijo_2163_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Affiliation(s)
- Santosh G Honavar
- Editor, Indian Journal of Ophthalmology, Centre for Sight, Road No 2, Banjara Hills, Hyderabad, Telangana, India. E-mail:
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10
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Singh R, Sharma AK, Katiyar V, Kumar G, Gupta SK. Corneal endothelial changes following cataract surgery in hard nuclear cataract: Randomized trial comparing phacoemulsification to manual small-incision cataract surgery. Indian J Ophthalmol 2022; 70:3904-3909. [PMID: 36308124 PMCID: PMC9907284 DOI: 10.4103/ijo.ijo_1304_22] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Purpose To evaluate and compare endothelial cell changes in phacoemulsification and manual small-incision cataract surgery (MSICS) in patients with uncomplicated senile cataracts. Methods: This was a prospective , tertiary care hospital-based, randomized, double-blinded interventional study. In total, 152 patients with an uncomplicated senile cataract of nuclear grade III and above were recruited. Exclusion criteria included patients with preoperative endothelial cell density (ECD) less than 1500 cells/mm3, a history of previous ocular surgery, any other coexisting ocular disease, and intraoperative or postoperative surgical complications. Preoperative and postoperative values of ECD and central corneal thickness (CCT) were measured, analyzed, and correlated with various factors. Results Patients were randomized into two interventional groups-MSICS and phacoemulsification. Factors associated with significant drop in postoperative ECD following phacoemulsification were patients with advanced age (P = 0.01), higher grades of cataract (P = 0.01), and longer effective phacoemulsification time (P = 0.007). Shallow anterior chamber depth (ACD) was strongly associated with greater ECD loss in both groups (P < 0.0001). A threshold value of 2.86 mm of ACD was defined for minimal endothelial cell loss following phacoemulsification. CCT was observed to slightly increase postoperatively in both groups but was insignificant (P > 0.05). Conclusion Both MSICS and phacoemulsification have similar postoperative visual outcomes. An increase in postoperative CCT is insignificant following surgery. Greater postoperative ECD loss is associated with phacoemulsification with advanced age, hard nuclear cataracts, and longer effective phacoemulsification time. ACD can be used as an essential parameter preoperatively to determine the choice of surgical technique between MSICS and phacoemulsification.
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Affiliation(s)
- Ritu Singh
- Department of Ophthalmology, King George’s Medical University, Lucknow, Uttar Pradesh, India
| | - Arun K Sharma
- Department of Ophthalmology, King George’s Medical University, Lucknow, Uttar Pradesh, India
| | - Vishal Katiyar
- Department of Ophthalmology, King George’s Medical University, Lucknow, Uttar Pradesh, India
| | - Gaurav Kumar
- Department of Ophthalmology, King George’s Medical University, Lucknow, Uttar Pradesh, India
| | - Sanjiv K Gupta
- Department of Ophthalmology, King George’s Medical University, Lucknow, Uttar Pradesh, India,Correspondence to: Prof. Sanjiv K Gupta, Department of Ophthalmology, King George’s Medical University, Lucknow, Uttar Pradesh, India. E-mail:
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Affiliation(s)
- Jagannath M Boramani
- Chairman, Editorial Board, IJO-MSICS Issue, Executive Chairman, ISMSICS, Surya Netralaya, 14, Shanti Centre, Sector 17, Vashi, Navi Mumbai - 400 703, India. E-mail:
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12
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Tejaswini A, Gurnani B, Kaur K, Sinha A, Bejjenki P, Jella N, Morya AK. Commentary: Evaluating affordability, cost-effectiveness, cost-utility, health economics, and incremental cost-effectiveness ratio of manual small-incision cataract surgery - The need of the hour. Indian J Ophthalmol 2022; 70:3771-3772. [PMID: 36308094 PMCID: PMC9907234 DOI: 10.4103/ijo.ijo_2232_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Affiliation(s)
- Antarvedi Tejaswini
- Department of Ophthalmology, All India Institute of Medical Sciences, Bibinagar, Hyderabad, Telangana, India
| | - Bharat Gurnani
- Cataract, Cornea, External Disease, Trauma, Ocular Surface and Refractive Surgery, Dr. Om Parkash Eye Institute, Amritsar, Punjab, India
| | - Kirandeep Kaur
- Cataract, Pediatric Ophthalmology and Strabismus, Dr. Om Parkash Eye Institute, Amritsar, Punjab, India
| | | | - Priyanka Bejjenki
- Department of Ophthalmology, All India Institute of Medical Sciences, Bibinagar, Hyderabad, Telangana, India
| | - Niharika Jella
- Department of Ophthalmology, All India Institute of Medical Sciences, Bibinagar, Hyderabad, Telangana, India
| | - Arvind Kumar Morya
- Cataract, Glaucoma, Refractive, Squnt, Paediatric Ophthalmology and Medical Retina Services, All India Institute of Medical Sciences Bibinagar, Hyderabad, Telangana, India,Correspondence to: Dr. Arvind Kumar Morya, Cataract, Glaucoma, Refractive, Squint, Pediatric Ophthalmology and Medical Retina Services, Department of Ophthalmology, All India Institute of Medical Sciences, Bibinagar, Hyderabad - 508 126, Telangana, India. E-mail:
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13
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Mishra D, Dixit N, Ranjan P. One step beyond tomorrow; Ranjan manual small-incision cataract surgery (MSICS) marker - Welcome to the topical, flapless and astigmatism-free MSICS era. Indian J Ophthalmol 2022; 70:4086-4088. [PMID: 36308169 PMCID: PMC9907308 DOI: 10.4103/ijo.ijo_1696_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
The prevalence of blindness in India is 14.9 per 1000. Cataract causes 80% of this blindness. Most of these blinds are in the rural areas while the surgical service delivery channels are concentrated in the urban areas. This situation has many social impacts like loss of productivity, breakdown of interpersonal relationships, depressive manifestations, loss of self-esteem, and isolated humiliating life. Manual small-incision cataract surgery (MSICS; also SICS) is a low-cost, small-incision, high-valued cataract surgery that is principally employed in the developing world. In poor settings, MSICS also has several distinct advantages over phacoemulsification, including shorter operative time, less need for technology, and lower cost. Ranjan MSICS Marker is a tool which enables MSICS to be done under topical anesthesia easily with more precise and safe incision making along with more control on surgery induced astigmatism.
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Affiliation(s)
- Deepak Mishra
- Associate Professor, Department of Ophthalmology, Regional Institute of Ophthalmology, Institute of Medical Sciences, Banaras Hindu University, Vranasi, Uttar Pradesh, India
| | - Nitish Dixit
- Phaco-Refractive Fellow, Medical Director at ASG Superspeciality Eye Hospital, Varanasi, Uttar Pradesh, India,Correspondence to: Dr. Nitish Dixit, Phaco-Refractive Fellow, ASG Superspeciality Eye Hospital, Ground Floor, Corporate Plaza, Near A.G.R Automobile, Rathyatra-Mahmoorganj Road, Gopal Vihar Colony, Mahmoorganj, Varanasi - 221 010, Uttar Pradesh, India. E-mail:
| | - Pratyush Ranjan
- Consultant Cataract, Refractive and Glaucoma Services, Medical Director at ASG Superspeciality Eye Hospital, Varanasi, Uttar Pradesh, India
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14
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Gogate P. Relevance of manual small-incision surgery in today's private practice setting. Indian J Ophthalmol 2022; 70:3757-3758. [PMID: 36308089 PMCID: PMC9907275 DOI: 10.4103/ijo.ijo_2170_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Affiliation(s)
- Parikshit Gogate
- Department of Ophthalmology, D. Y. Patil Medical College, Pune, Maharashtra, India,Community Eye Care Foundation, Dr. Gogate’s Eye Clinic, Pune, Maharashtra, India,School of Health Sciences, Queens University, Belfast, United Kingdom. E-mail:
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15
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Gurnani B, Mishra D, Kaur K, Heda A, Sahu A. Evolution of manual small-incision cataract surgery from 8 mm to 2 mm - A comprehensive review. Indian J Ophthalmol 2022; 70:3773-3778. [PMID: 36308095 PMCID: PMC9907246 DOI: 10.4103/ijo.ijo_1567_22] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Cataract is the most common cause of reversible blindness worldwide, accounting for approximately 50% of blindness worldwide. Cataract surgery is the most common surgical procedure performed in routine ophthalmic practice. It has undergone tremendous evolution, and the incision size has progressively reduced from 10-12 mm in extracapsular cataract surgery (ECCE) to 6-8 mm for manual small-incision cataract surgery (MSICS) and 2.2-2.8 mm in phacoemulsification. In a developing country like India, with a massive backlog of cataract, everyone cannot afford private surgery like phacoemulsification. Moreover, annual maintenance of the machine, cost of foldable IOLs, need for greater skill, learning curve, and difficulty in performing the surgery in mature and brown cataracts are other barriers. Due to these factors, MSICS is the surgery of choice in the developing world, with profound societal and economic benefits and similar visual recovery compared to phacoemulsification. During the last two decades, MSICS gained popularity in developing countries and has undergone tremendous advances. This article aims to review the various techniques of MSICS and how the surgery has evolved over the years, particularly focusing on the current technique of 2-mm MSICS.
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Affiliation(s)
- Bharat Gurnani
- Consultant Cataract, Cornea and Refractive Services, Amritsar, Punjab, India
| | - Deepak Mishra
- Associate Professor, Department of Ophthalmology, Regional Institute of Ophthalmology, Banaras Hindu University, Varanasi, Uttar Pradesh, India,Correspondence to: Dr. Deepak Mishra, Associate Professor, Regional Institute of Ophthalmology, Institute of Medical Sciences, Banaras Hindu University, Varanasi, Uttar Pradesh, India. E-mail:
| | - Kirandeep Kaur
- Consultant Cataract, Pediatric Ophthalmology and Strabismus Services, Dr. Om Parkash Eye Institute, Amritsar, Punjab, India
| | - Aarti Heda
- Consultant Glaucoma, National Institute of Ophthalmology, Pune, Maharashtra, India
| | - Amulya Sahu
- Department of Ophthalmology, Sahu Eye Hospital and Kamal Nethralay Pvt Ltd, Mumbai, Maharashtra, India
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Vaiciuliene R, Rylskyte N, Baguzyte G, Jasinskas V. Risk factors for fluctuations in corneal endothelial cell density (Review). Exp Ther Med 2022; 23:129. [PMID: 34970352 PMCID: PMC8713183 DOI: 10.3892/etm.2021.11052] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2021] [Accepted: 10/29/2021] [Indexed: 12/17/2022] Open
Abstract
The cornea is a transparent, avascular and abundantly innervated tissue through which light rays are transmitted to the retina. The innermost layer of the cornea, also known as the endothelium, consists of a single layer of polygonal endothelial cells that serve an important role in preserving corneal transparency and hydration. The average corneal endothelial cell density (ECD) is the highest at birth (~3,000 cells/mm2), which then decrease to ~2,500 cells/mm2 at adulthood. These endothelial cells have limited regenerative potential and the minimum (critical) ECD required to maintain the pumping function of the endothelium is 400-500 cells/mm2. ECD < the critical value can result in decreased corneal transparency, development of corneal edema and reduced visual acuity. The condition of the corneal endothelium can be influenced by a number of factors, including systemic diseases, such as diabetes or atherosclerosis, eye diseases, such as uveitis or dry eye disease (DED) and therapeutic ophthalmological interventions. The aim of the present article is to review the impact of the most common systemic disorders (pseudoexfoliation syndrome, diabetes mellitus, cardiovascular disease), eye diseases (DED, uveitis, glaucoma, intraocular lens dislocation) and widely performed ophthalmic interventions (cataract surgery, intraocular pressure-lowering surgeries) on corneal ECD.
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Affiliation(s)
- Renata Vaiciuliene
- Department of Ophthalmology, Medical Academy, Lithuanian University of Health Sciences, LT-50161 Kaunas, Lithuania
| | - Neda Rylskyte
- Faculty of Medicine, Lithuanian University of Health Sciences, LT-44307 Kaunas, Lithuania
| | - Gabija Baguzyte
- Department of Ophthalmology, Medical Academy, Lithuanian University of Health Sciences, LT-50161 Kaunas, Lithuania
| | - Vytautas Jasinskas
- Department of Ophthalmology, Medical Academy, Lithuanian University of Health Sciences, LT-50161 Kaunas, Lithuania
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17
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Rajendran S, Rajalakshmi AR, Srikanth K, Ezhumalai G. Manual small incision cataract surgery: a viable option for cataract with pseudoexfoliation. Int Ophthalmol 2021; 42:1447-1455. [PMID: 34839453 DOI: 10.1007/s10792-021-02134-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2021] [Accepted: 11/12/2021] [Indexed: 10/19/2022]
Abstract
PURPOSE The aim of the study was to assess the spectrum of clinical presentation, intraoperative challenges and immediate surgical outcome of cataract patients with pseudoexfoliation syndrome (PXF) following manual small incision cataract surgery (MSICS). METHODS This prospective observational study which was conducted in a rural tertiary care hospital included adult patients with cataract and associated PXF. MSICS was performed for all after a complete ophthalmic and systemic examination. Clinical profile, intraoperative and post-operative complications were noted. Uncorrected visual acuity on first day post-surgery was used to assess the surgical outcome following MSICS. RESULTS MSICS was performed in 80 eyes with varying grades of cataract and PXF. The mean age of the patients was 62.5 ± 8.9 years. PXF material on pupillary margin in 77(96%) patients was the most common finding noted. Majority of the patients had advanced cataract (72, 90%) and inadequate mydriasis (62, 77.5%). Posterior capsular rent (8, 10%) and zonular dehiscence (8, 10%) were the intraoperative difficulties faced. Uncorrected visual outcome on first post-operative day was moderate to good in 71 (88.8%) patients, limited by post-operative corneal oedema (21, 26.3%), iritis (31, 38.8%) and aphakia (9, 11.3%). CONCLUSION Patients with pseudoexfoliation had poor pupillary dilatation, advanced cataracts and higher rate of posterior capsular rent. Our study showed good outcome of MSICS in PXF patients, even with advanced cataract suggesting that MSICS is a safe, effective and viable option for patients with PXF and cataract.
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Affiliation(s)
- Sruthi Rajendran
- Anand Eye Hospital Clear Vision Centre, Trivandrum, Kerala, India.,Department of Ophthalmology, Mahatma Gandhi Medical College & Research Institute, Sri Balaji Vidyapeeth (SBV) Deemed to be University, Pondicherry, 607402, India
| | - A R Rajalakshmi
- Department of Ophthalmology, Mahatma Gandhi Medical College & Research Institute, Sri Balaji Vidyapeeth (SBV) Deemed to be University, Pondicherry, 607402, India.
| | - K Srikanth
- Department of Ophthalmology, Mahatma Gandhi Medical College & Research Institute, Sri Balaji Vidyapeeth (SBV) Deemed to be University, Pondicherry, 607402, India
| | - G Ezhumalai
- Senior Statistician & Research consultant, Mahatma Gandhi Medical College & Research Institute, Sri Balaji Vidyapeeth (SBV) Deemed to be University, Pondicherry, 607402, India
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18
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Morkos FF, Fawzy NF, El Bahrawy M, Elkitkat RS. Introduction of longstanding complicated sulcus intraocular lens into the intact capsular bag. Int J Ophthalmol 2021; 14:1779-1783. [PMID: 34804870 DOI: 10.18240/ijo.2021.11.19] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2021] [Accepted: 07/01/2021] [Indexed: 11/23/2022] Open
Abstract
AIM To propose a surgical technique that successfully reopened the empty and intact capsular bag after long periods of closure, with repositioning of the intraocular lens (IOL) from the ciliary sulcus into its preferred habitat inside the capsular bag. METHODS This is a case series, prospective, and interventional study. The technique was first performed on an aphakic high myope with a closed posterior capsule for 18y. Afterwards, five patients with recurrently displaced sulcus IOLs for a range of 1mo to 7y were performed for the same technique. During surgery, identifying a "telltale white line" was an important landmark for detecting the site of major adhesions between the edge of the capsulorhexis and the posterior capsule. These adhesions were freed using combined manual and viscoelastic dissection, followed by an easier freeing of adhesions along the whole capsular bag. The IOL was safely implanted, exchanged, or introduced from the sulcus into the fibrotic and closed capsular bag. Patients were followed up for a period ranging from 6 to 17mo postoperatively. RESULTS All the patients experienced a remarkable improvement in their subjective refraction. Slit lamp examination showed a postoperative centralized IOL in the bag. The follow up visits confirmed visual and IOL stability. CONCLUSION This newly-introduced surgical technique facilitates the reopening of the empty yet intact capsular bag that has been closed by fibrotic proliferations, with secured implantation of the IOL inside the capsular bag. Patients with inadvertent implantation of IOLs into the ciliary sulcus, yet having an intact capsular bag, can benefit from this technique.
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Affiliation(s)
- Fathy Fawzy Morkos
- Watany Research and Development Center, Watany Eye Hospital, Cairo 11799, Egypt
| | - Nader Fathy Fawzy
- Watany Research and Development Center, Watany Eye Hospital, Cairo 11799, Egypt
| | - Mohamed El Bahrawy
- Watany Research and Development Center, Watany Eye Hospital, Cairo 11799, Egypt
| | - Rania Serag Elkitkat
- Watany Research and Development Center, Watany Eye Hospital, Cairo 11799, Egypt.,Department of Ophthalmology, Faculty of Medicine, Ain Shams University, Cairo 11799, Egypt
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19
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Ajay K, Subhasree RK, Poka A. Anterior Subconjunctival Anesthesia for Manual Small Incision Cataract Surgery: A Randomized Controlled Trial. J Curr Ophthalmol 2021; 33:266-271. [PMID: 34765813 PMCID: PMC8579797 DOI: 10.4103/2452-2325.329083] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2020] [Revised: 05/01/2021] [Accepted: 05/02/2021] [Indexed: 11/04/2022] Open
Abstract
Purpose: To compare the effectiveness of anterior subconjunctival anesthesia (ASCA) with sub-tenon's anesthesia (STA) for manual small incision cataract surgery (MSICS), regarding pain, akinesia, surgeon comfort, and complications. Methods: This trial randomized 164 patients into two groups. Group 1 received ASCA, and Group 2 received STA. MSICS was performed on all patients. Any complications of anesthesia were noted before starting surgery. Patient ocular motility during surgery was scored between 0 and 4 based on the number of directions of gaze in which movement persisted. Following surgery, patients scored pain felt during surgery on a visual pain-score analog, and the surgeon graded for “discomfort” felt during surgery from 0 (Nil) to 4 (additional anesthesia needed). Results: Chemosis due to anesthesia and persistence of ocular motility in all four gaze directions were seen in all 82 patients of Group 1, but these did not prevent the surgeon from performing MSICS. Seventy-seven patients (94%) in Group 1 and 79 (96.4%) in Group 2 had no or mild pain during surgery. The surgeon had moderate-to-severe discomfort in 14 (17.2%) Group 1 patients and 3 (3.6%) Group 2 patients, most of whom had deep-set eyes or exhibited excessive eye movements. Two patients in Group 1 and one patient in Group 2 were converted to peribulbar block. Conclusion: ASCA is a safe and effective alternative for performing MSICS. It does not induce akinesia but provides adequate anesthesia for the surgery in most patients, except those with deep-set eyes, especially if displaying increased anxiety.
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Affiliation(s)
- K Ajay
- Department of Ophthalmology, The Oxford Medical College Hospital and Research Center, Bengaluru, Karnataka, India
| | - Revuru Kanaka Subhasree
- Department of Ophthalmology, P. E. S. Institute of Medical Sciences and Research, Kuppam, Andhra Pradesh, India
| | - Avinash Poka
- Department of Ophthalmology, P. E. S. Institute of Medical Sciences and Research, Kuppam, Andhra Pradesh, India
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20
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Visual outcomes of high-volume compared with low-volume manual small-incision cataract surgery in Nepal. J Cataract Refract Surg 2021; 46:1119-1125. [PMID: 32352252 DOI: 10.1097/j.jcrs.0000000000000217] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE To study whether manual small-incision cataract surgery (MSICS) in a high-volume setting gives acceptable postoperative visual outcomes. SETTINGS Geta Eye Hospital, Kailali, Nepal. DESIGN Single-center retrospective study. METHODS One-year records of all MSICS in adult patients without any other ocular comorbidity were analyzed retrospectively. Surgical outcomes of cataract cases when surgeons performed more than 72 surgeries (high volume) in a single operating session (1 day) were compared with when fewer than 30 surgeries (low volume) were performed in a single operating session (1 day). RESULTS Of 23 717 cases in the study, 20 574 patients (87%) had preoperative visual acuity of less than 3/60; 15 632 patients (66%) achieved good visual outcome (uncorrected distance visual acuity of 6/18 or better) postoperatively. Patients operated during high-volume months achieved good visual outcomes in 9930 cases (66.9%) as compared with 5702 (64.3%) in low-volume months. However, 6235 patients (61.7%) operated on during high-volume days had good visual outcomes as compared with 3053 (71.4%) during low-volume days; 175 patients in the high-volume group and 73 patients in the low-volume group (1.7% each) achieved visual acuity worse than 3/60. There were comparable posterior capsular rupture rates (423 [1.78%]) during high- and low-volume months, and 21 cases (0.09%) of postoperative endophthalmitis were noted. CONCLUSIONS MSICS can be used to reduce large cataract backlogs in developing countries as good visual outcomes could be achieved in high-volume settings if standard protocols for quality control are followed.
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21
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Maswadi R, Bascaran C, Clare G, Ramada MA, AlTalbishi A, Foster A. Cataract Surgical Services in Palestine. Ophthalmic Epidemiol 2021; 29:223-231. [PMID: 34121602 DOI: 10.1080/09286586.2021.1923755] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
Purpose: Cataract surgery, quantity and quality, is an indicator of ophthalmic care. A comprehensive assessment of cataract surgical services has never been carried out in Palestine, including West Bank, Gaza Strip and East Jerusalem. The objective of this study was to estimate the cataract surgical rate in 2015 to and to explore the modes of payment and referral systems.Methods: A cross-sectional study conducted between June and August 2016. Medical Directors from Cataract Surgical Centres in Palestine were interviewed using a structured questionnaire to extract data on cataract output and surgical techniques. Additionally, data were collected on modes of payment for cataract services. The cataract surgical rate was calculated by dividing the total cataract output in 2015 by the estimated population of Palestine in millions.Results: In 2015, 9908 cataract surgeries were carried out in 22 centres. The cataract surgical rate was 2,117 operations per million population. Phacoemulsification was the most common technique (73.4%), however in government centres 67% were performed by extracapsular cataract extraction.In the Gaza Strip, 56.6% of cataract surgeries were operated at government centres, and 42.8% were operated at NGO centres while in West Bank, only 12% of cataract surgeries were operated at government centres, with two-thirds of cataracts diagnosed at governmental centres being referred to private and NGO centres. Seventy eight percent of cataract surgeries were funded by insurance, of which the government insurance scheme contributed 65%.Conclusion: The cataract surgical rate in Palestine falls short of the required WHO target. The majority of cataract surgeries are funded by insurance.
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Affiliation(s)
- Ranad Maswadi
- London School of Hygiene and tropical medicine, London, UK
| | | | - Gerry Clare
- Guy;s and St Thomas' NHS Foundation Trust, Medical Retina Department, London, UK
| | - Maged Abu Ramada
- Department is :Cornea and Cataract Department, Gaza Eye Centre, Gaza City, Gaza Strip, Palestine
| | | | - Allen Foster
- London School of Hygiene and tropical medicine, London, UK
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22
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Gogate P. Commentary: Lying down looking down test: Evaluating patient suitability for small incision cataract surgery using assisted topical anesthesia. Indian J Ophthalmol 2021; 69:273-274. [PMID: 33463572 PMCID: PMC7933856 DOI: 10.4103/ijo.ijo_2418_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Affiliation(s)
- Parikshit Gogate
- Community Eye Care Foundation, Dr. Gogate's Eye Clinic; Department of Ophthalmology, D.Y. Patil Medical College, Pune, Maharashtra, India; Honorary Lecturer, School of Medicine, Dentistry and Biomedical Engineering, Queens University, Belfast, United Kingdom
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23
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Rajput VK, Bhalsing S, Bhalsing S, Raut P. Lying down looking down test: Evaluating patient suitability for small incision cataract surgery using assisted topical anesthesia. Indian J Ophthalmol 2021; 69:268-273. [PMID: 33463571 PMCID: PMC7933868 DOI: 10.4103/ijo.ijo_280_20] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Purpose: The objective of this study was to evaluate an OPD-based Lying down looking down (LDLD) test for the assessment of patient suitability for assisted topical anesthesia (ATA) during manual small incision cataract surgery (MSICS), and to compare it with assisted local anesthesia (ALA). Methods: The LDLD test was carried out during preoperative assessment of 250 consecutive patients. A standard LED torch was shined in patient's eye after pupil dilation, with the patient in lying down position, while simultaneously elevating the upper eyelid digitally. A positive test was indicated by the ability to maintain downward gaze and the lack of squeezing of eyes or withdrawal. Chi-square and Fisher's exact tests were used to assess the association between LDLD results and suitability for ATA. The positive predictive value and specificity of the test as an indicator of patient suitability for ATA were calculated. Complications (intra- and post-operative) and postoperative inflammation at day 1 and week 6 were compared between the ATA and ALA groups. Results: A total of 250 patients were included in the study, 138 in ALA group and 112 in ATA group. There were 109 males (43.6%) and 141 females (56.4%). Around 7.4% of LDLD- positive patients were converted to ALA during the surgery. Chi-square and Fisher's exact tests demonstrated a significant association of a positive LDLD test with successful ATA (P value 0.002). The positive predictive value and specificity of the test were 92.56% (95% CI86.87-95.9%) and 93.48% (95% CI87.98-96.97%), respectively. Intraoperative complications were similar in both the groups. Congestion and visually significant corneal edema were significantly less in ATA group. Conclusion: The LDLD is a simple, highly specific, OPD-based test to determine patient suitability for MSICS under ATA
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Affiliation(s)
- Vimal K Rajput
- Department of Pediatric Ophthalmology and Strabismus, Prime Vision Superspeciality Eye Care, Ahmednagar, Maharashtra, India
| | - Shweta Bhalsing
- Department of Cataract Services, Prime Vision Superspeciality Eye Care, Ahmednagar, Maharashtra, India
| | - Snehal Bhalsing
- Department of Vitreoretinal Services, Prime Vision Superspeciality Eye Care, Ahmednagar, Maharashtra, India
| | - Pritish Raut
- Department of Preventive and Social Medicine, DVVPF, Ahmednagar, Maharashtra, India
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24
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Goel H, Wemyss TA, Harris T, Steinbach I, Stancliffe R, Cassels-Brown A, Thomas PBM, Thiel CL. Improving productivity, costs and environmental impact in International Eye Health Services: using the 'Eyefficiency' cataract surgical services auditing tool to assess the value of cataract surgical services. BMJ Open Ophthalmol 2021; 6:e000642. [PMID: 34104796 PMCID: PMC8141432 DOI: 10.1136/bmjophth-2020-000642] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2020] [Revised: 03/30/2021] [Accepted: 04/29/2021] [Indexed: 11/25/2022] Open
Abstract
Objective Though one of the most common surgeries, there is limited information on variability of practices in cataract surgeries. ‘Eyefficiency’ is a cataract surgical services auditing tool to help global units improve their surgical productivity and reduce their costs, waste generation and carbon footprint. The aim of the present research is to identify variability and efficiency opportunities in cataract surgical practices globally. Methods and Analysis 9 global cataract surgical facilities used the Eyefficiency tool to collect facility-level data (staffing, pathway steps, costs of supplies and energy use), and live time-and-motion data. A point person from each site gathered and reported data on 1 week or 30 consecutive cataract surgeries. Environmental life cycle assessment and descriptive statistics were used to quantify productivity, costs and carbon footprint. The main outcomes were estimates of productivity, costs, greenhouse gas emissions, and solid waste generation per-case at each site. Results Nine participating sites recorded 475 cataract extractions (a mix of phacoemulsification and manual small incision). Cases per hour ranged from 1.7 to 4.48 at single-bed sites and 1.47 to 4.25 at dual-bed sites. Average per-case expenditures ranged between £31.55 and £399.34, with a majority of costs attributable to medical equipment and supplies. Average solid waste ranged between 0.19 kg and 4.27 kg per phacoemulsification, and greenhouse gases ranged from 41 kg carbon dioxide equivalents (CO2e) to 130 kg CO2e per phacoemulsification. Conclusion Results demonstrate the global diversity of cataract surgical services and non-clinical metrics. Eyefficiency supports local decision-making for resource efficiency and could help identify regional or global best practices for optimising productivity, costs and environmental impact of cataract surgery.
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Affiliation(s)
- Hena Goel
- Population Health, NYU Langone Health, New York, New York, USA
| | - Thomas Alan Wemyss
- Department of Medical Physics and Biomedical Engineering, University College London, London, UK
| | - Tanya Harris
- Edge Environment, Melbourne, Victoria, Australia
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25
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Burton MJ, Ramke J, Marques AP, Bourne RRA, Congdon N, Jones I, Ah Tong BAM, Arunga S, Bachani D, Bascaran C, Bastawrous A, Blanchet K, Braithwaite T, Buchan JC, Cairns J, Cama A, Chagunda M, Chuluunkhuu C, Cooper A, Crofts-Lawrence J, Dean WH, Denniston AK, Ehrlich JR, Emerson PM, Evans JR, Frick KD, Friedman DS, Furtado JM, Gichangi MM, Gichuhi S, Gilbert SS, Gurung R, Habtamu E, Holland P, Jonas JB, Keane PA, Keay L, Khanna RC, Khaw PT, Kuper H, Kyari F, Lansingh VC, Mactaggart I, Mafwiri MM, Mathenge W, McCormick I, Morjaria P, Mowatt L, Muirhead D, Murthy GVS, Mwangi N, Patel DB, Peto T, Qureshi BM, Salomão SR, Sarah V, Shilio BR, Solomon AW, Swenor BK, Taylor HR, Wang N, Webson A, West SK, Wong TY, Wormald R, Yasmin S, Yusufu M, Silva JC, Resnikoff S, Ravilla T, Gilbert CE, Foster A, Faal HB. The Lancet Global Health Commission on Global Eye Health: vision beyond 2020. Lancet Glob Health 2021; 9:e489-e551. [PMID: 33607016 PMCID: PMC7966694 DOI: 10.1016/s2214-109x(20)30488-5] [Citation(s) in RCA: 500] [Impact Index Per Article: 166.7] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2020] [Revised: 10/21/2020] [Accepted: 11/02/2020] [Indexed: 01/19/2023]
Affiliation(s)
- Matthew J Burton
- International Centre for Eye Health, London School of Hygiene & Tropical Medicine, London, UK; National Institute for Health Research Biomedical Research Centre for Ophthalmology at Moorfields Eye Hospital NHS Foundation Trust and UCL Institute of Ophthalmology, London, UK.
| | - Jacqueline Ramke
- International Centre for Eye Health, London School of Hygiene & Tropical Medicine, London, UK; School of Optometry and Vision Science, University of Auckland, Auckland, New Zealand
| | - Ana Patricia Marques
- International Centre for Eye Health, London School of Hygiene & Tropical Medicine, London, UK
| | - Rupert R A Bourne
- Vision and Eye Research Institute, Anglia Ruskin University, Cambridge, UK; Department of Ophthalmology, Cambridge University Hospitals, Cambridge, UK
| | - Nathan Congdon
- Centre for Public Health, Queen's University Belfast, Belfast, UK; Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou, China
| | | | | | - Simon Arunga
- International Centre for Eye Health, London School of Hygiene & Tropical Medicine, London, UK; Department of Ophthalmology, Mbarara University of Science and Technology, Mbarara, Uganda
| | - Damodar Bachani
- John Snow India, New Delhi, India; Ministry of Health and Family Welfare, New Delhi, India
| | - Covadonga Bascaran
- International Centre for Eye Health, London School of Hygiene & Tropical Medicine, London, UK
| | - Andrew Bastawrous
- International Centre for Eye Health, London School of Hygiene & Tropical Medicine, London, UK; Peek Vision, London, UK
| | - Karl Blanchet
- Geneva Centre of Humanitarian Studies, University of Geneva, Geneva, Switzerland
| | - Tasanee Braithwaite
- International Centre for Eye Health, London School of Hygiene & Tropical Medicine, London, UK; The Medical Eye Unit, St Thomas' Hospital, London, UK
| | - John C Buchan
- International Centre for Eye Health, London School of Hygiene & Tropical Medicine, London, UK; Leeds Teaching Hospitals NHS Trust, Leeds, UK
| | - John Cairns
- Department of Health Services Research and Policy, London School of Hygiene & Tropical Medicine, London, UK
| | | | | | - Chimgee Chuluunkhuu
- Orbis International, Ulaanbaatar, Mongolia; Mongolian Ophthalmology Society, Ulaanbaatar, Mongolia
| | | | | | - William H Dean
- International Centre for Eye Health, London School of Hygiene & Tropical Medicine, London, UK; Division of Ophthalmology, University of Cape Town, Cape Town, South Africa
| | - Alastair K Denniston
- National Institute for Health Research Biomedical Research Centre for Ophthalmology at Moorfields Eye Hospital NHS Foundation Trust and UCL Institute of Ophthalmology, London, UK; Ophthalmology Department, University Hospital Birmingham NHS Foundation Trust, Queen Elizabeth Hospital Birmingham, Birmingham, UK; Health Data Research UK, London, UK
| | - Joshua R Ehrlich
- Department of Ophthalmology and Visual Sciences, University of Michigan, Ann Arbor, MI, USA; Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor, MI, USA
| | - Paul M Emerson
- International Trachoma Initiative and Rollins School of Public Health, Emory University, Atlanta, GA, USA
| | - Jennifer R Evans
- International Centre for Eye Health, London School of Hygiene & Tropical Medicine, London, UK
| | - Kevin D Frick
- Carey Business School, Johns Hopkins University, Baltimore, MD, USA
| | - David S Friedman
- Massachusetts Eye and Ear, Harvard Ophthalmology, Harvard Medical School, Boston, MA, USA
| | - João M Furtado
- Ribeirão Preto Medical School, University of São Paulo, São Paulo, Brazil
| | | | - Stephen Gichuhi
- Department of Ophthalmology, University of Nairobi, Nairobi, Kenya
| | | | - Reeta Gurung
- Tilganga Institute of Ophthalmology, Kathmandu, Nepal
| | - Esmael Habtamu
- International Centre for Eye Health, London School of Hygiene & Tropical Medicine, London, UK; Eyu-Ethiopia Eye Health Research, Training, and Service Centre, Bahirdar, Ethiopia
| | - Peter Holland
- International Agency for the Prevention of Blindness, London, UK
| | - Jost B Jonas
- Institute of Clinical and Scientific Ophthalmology and Acupuncture Jonas and Panda, Heidelberg, Germany; Department of Ophthalmology, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany; Institute of Molecular and Clinical Ophthalmology Basel, Basel, Switzerland
| | - Pearse A Keane
- National Institute for Health Research Biomedical Research Centre for Ophthalmology at Moorfields Eye Hospital NHS Foundation Trust and UCL Institute of Ophthalmology, London, UK
| | - Lisa Keay
- School of Optometry and Vision Science, University of New South Wales, Sydney, Australia; George Institute for Global Health, University of New South Wales, Sydney, Australia
| | - Rohit C Khanna
- School of Optometry and Vision Science, University of New South Wales, Sydney, Australia; Gullapalli Pratibha Rao International Centre for Advancement of Rural Eye Care, LV Prasad Eye Institute, Hyderabad, India; Brien Holden Eye Research Centre, LV Prasad Eye Institute, Hyderabad, India
| | - Peng Tee Khaw
- National Institute for Health Research Biomedical Research Centre for Ophthalmology at Moorfields Eye Hospital NHS Foundation Trust and UCL Institute of Ophthalmology, London, UK
| | - Hannah Kuper
- International Centre for Evidence in Disability, London School of Hygiene & Tropical Medicine, London, UK
| | - Fatima Kyari
- International Centre for Eye Health, London School of Hygiene & Tropical Medicine, London, UK; College of Health Sciences, University of Abuja, Abuja, Nigeria
| | - Van C Lansingh
- Instituto Mexicano de Oftalmologia, Queretaro, Mexico; Centro Mexicano de Salud Visual Preventiva, Mexico City, Mexico; Help Me See, New York, NY, USA
| | - Islay Mactaggart
- International Centre for Eye Health, London School of Hygiene & Tropical Medicine, London, UK; International Centre for Evidence in Disability, London School of Hygiene & Tropical Medicine, London, UK
| | - Milka M Mafwiri
- Department of Ophthalmology, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
| | | | - Ian McCormick
- International Centre for Eye Health, London School of Hygiene & Tropical Medicine, London, UK
| | - Priya Morjaria
- International Centre for Eye Health, London School of Hygiene & Tropical Medicine, London, UK
| | - Lizette Mowatt
- University Hospital of the West Indies, Kingston, Jamaica
| | - Debbie Muirhead
- The Fred Hollows Foundation, Melbourne, Australia; Nossal Institute for Global Health, University of Melbourne, Melbourne, VIC, Australia
| | - Gudlavalleti V S Murthy
- International Centre for Eye Health, London School of Hygiene & Tropical Medicine, London, UK; Indian Institute of Public Health, Hyderabad, India
| | - Nyawira Mwangi
- International Centre for Eye Health, London School of Hygiene & Tropical Medicine, London, UK; Kenya Medical Training College, Nairobi, Kenya
| | - Daksha B Patel
- International Centre for Eye Health, London School of Hygiene & Tropical Medicine, London, UK
| | - Tunde Peto
- Centre for Public Health, Queen's University Belfast, Belfast, UK
| | | | - Solange R Salomão
- Departamento de Oftalmologia e Ciências Visuais, Escola Paulista de Medicina, Universidade Federal de São Paulo, São Paulo, Brazil
| | | | - Bernadetha R Shilio
- Department of Curative Services, Ministry of Health Community Development, Gender, Elderly, and Children, Dodoma, Tanzania
| | - Anthony W Solomon
- Department of Control of Neglected Tropical Diseases, WHO, Geneva, Switzerland
| | - Bonnielin K Swenor
- Dana Center for Preventive Ophthalmology, Wilmer Eye Institute, Johns Hopkins University, Baltimore, MD, USA; Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, USA
| | - Hugh R Taylor
- Melbourne School of Population and Global Health, University of Melbourne, Melbourne, VIC, Australia
| | - Ningli Wang
- Beijing Institute of Ophthalmology, Beijing Tongren Eye Center, Beijing Tongren Hospital, Capital Medical University, Beijing, China; Beijing Ophthalmology and Visual Sciences Key Laboratory, Beijing, China
| | - Aubrey Webson
- Permanent Mission of Antigua and Barbuda to the United Nation, New York, NY, USA
| | - Sheila K West
- Dana Center for Preventive Ophthalmology, Wilmer Eye Institute, Johns Hopkins University, Baltimore, MD, USA
| | - Tien Yin Wong
- Singapore Eye Research Institute, Singapore National Eye Center, Singapore; Duke-NUS Medical School, Singapore
| | - Richard Wormald
- International Centre for Eye Health, London School of Hygiene & Tropical Medicine, London, UK; National Institute for Health Research Biomedical Research Centre for Ophthalmology at Moorfields Eye Hospital NHS Foundation Trust and UCL Institute of Ophthalmology, London, UK
| | | | - Mayinuer Yusufu
- Beijing Institute of Ophthalmology, Beijing Tongren Eye Center, Beijing Tongren Hospital, Capital Medical University, Beijing, China; Beijing Ophthalmology and Visual Sciences Key Laboratory, Beijing, China
| | | | - Serge Resnikoff
- School of Optometry and Vision Science, University of New South Wales, Sydney, Australia; Brien Holden Vision Institute, University of New South of Wales, Sydney, Australia
| | | | - Clare E Gilbert
- International Centre for Eye Health, London School of Hygiene & Tropical Medicine, London, UK
| | - Allen Foster
- International Centre for Eye Health, London School of Hygiene & Tropical Medicine, London, UK
| | - Hannah B Faal
- Department of Ophthalmology, University of Calabar, Calabar, Nigeria; Africa Vision Research Institute, Durban, South Africa
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Ting DSJ, Chua D, May KO, Aung M, Kumar A, Farook M, Htoon HM, C A Sng C, Ang M. Modified manual small incision cataract surgery technique for phacoemulsification-trained surgeons. Ther Adv Ophthalmol 2020; 12:2515841420977372. [PMID: 33344883 PMCID: PMC7727050 DOI: 10.1177/2515841420977372] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2020] [Accepted: 10/23/2020] [Indexed: 01/09/2023] Open
Abstract
Purpose: To present the technique and outcomes of a modified manual small incision cataract surgery designed for the phacoemulsification surgeons who are learning to perform manual small incision cataract surgery. Methods: This was a retrospective, single-centred, comparative study. We included all the patients who underwent the modified manual small incision cataract surgery for visually significant cataract at Singapore National Eye Centre. All surgeries were performed by either a senior phaco-trained surgeon (M.A.) who had performed more than 500 manual small incision cataract surgery or a junior phaco-trained surgeon (D.C.) who had performed around 500 phacoemulsification but never performed any manual small incision cataract surgery. The main modification of this technique lies in the creation of an additional phaco-like main wound at 90° to the scleral tunnel wound, with most surgical steps performed through this additional wound. The outcomes were analysed and compared between the senior and junior surgeons. The main outcome measures were visual outcome and major intraoperative complications such as posterior capsular rupture and zonular dialysis. Results: A total of 132 cases were included; 102 (77.3%) and 30 (22.7%) cases were performed by the senior and junior surgeons, respectively. Pre-operatively, 85.6% eyes had best-corrected visual acuity of counting fingers or worse. Postoperatively, the visual outcome at 1 month was similar between the senior and junior surgeons, with 68.7% eyes achieving a best-corrected visual acuity of ⩾6/12 (p = 0.17). No posterior capsular rupture, zonular dialysis or endophthalmitis was observed during the study period. Conclusions: This modified technique may serve as a useful transition technique for the phaco-trained surgeons to develop skills in manual small incision cataract surgery, with demonstrable good visual outcome and safety.
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Affiliation(s)
- Darren S J Ting
- Academic Ophthalmology, School of Medicine, University of Nottingham, Nottingham, UK
| | | | - Khin Oo May
- Sitagu International Missionary Association, Yangon, UK
| | - Mya Aung
- Sitagu International Missionary Association, Yangon, UK
| | | | | | - Hla M Htoon
- Singapore Eye Research Institute, Singapore; Ophthalmology and Visual Sciences, Duke - NUS Graduate Medical School, Singapore
| | - Chelvin C A Sng
- Singapore Eye Research Institute, Singapore; Department of Ophthalmology, National University Hospital, Singapore
| | - Marcus Ang
- Singapore National Eye Centre, 11 Third Hospital Avenue, Singapore 168751
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Jain S, Chauhan A, Rajshekar K, Vashist P, Gupta P, Mathur U, Gupta N, Gupta V, Dutta P, Gauba VK. Generic and vision related quality of life associated with different types of cataract surgeries and different types of intraocular lens implantation. PLoS One 2020; 15:e0240036. [PMID: 33007038 PMCID: PMC7531837 DOI: 10.1371/journal.pone.0240036] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2020] [Accepted: 09/17/2020] [Indexed: 12/02/2022] Open
Abstract
OBJECTIVES To assess the effects of different types of cataract surgeries and intraocular lenses on generic as well as vision related quality of life of cataract patients, using EQ-5D and IND-VFQ 33 instruments respectively. METHODS An observational, longitudinal study of patients undergoing cataract surgery was carried out at three ophthalmology centres. Patients were prospectively admitted for surgery for age-related cataract. Generic quality of life was assessed by using Euroqol's EQ5D-5L questionnaire and vision related quality of life was assessed by the IND-VFQ-33 questionnaire. Data pertaining to vision function and quality of life were collected pre surgery and 4 weeks after the surgery. RESULTS Out of total patients (n = 814) recruited for the study, 517 patients were interviewed for both pre-surgery and post-surgery for EQ5D and 519 patients were interviewed for both pre-surgery and post-surgery for IND VFQ 33 tool. The combined data from all three centres showed that Quality Adjusted Life Year (QALY) gains observed in patients undergoing phacoemulsification with foldable lens implantation (2.25 QALY) were significantly higher (0.57 QALY) as compared to Small Incision Cataract Surgery (SICS) with PMMA lens implantation (1.68 QALY). Highest improvement however, in all three subscales of IND-VFQ-33 tool were clearly observed for SICS with PMMA lens implantation. CONCLUSIONS The study has elicited the Health related and vision related Quality of Life scores for cataract surgeries and subsequent lens implantation. This study also offers Health State Utility Values along with visual outcomes for different surgical procedures, lenses and for the combination of surgery with lens implantation for cataract procedures providing a useful resource for future economic evaluation studies.
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Affiliation(s)
- Shalu Jain
- Health Technology Assessment in India, Department of Health Research, Ministry of Health and Family Welfare, New Delhi, India
| | - Akshay Chauhan
- Health Technology Assessment in India, Department of Health Research, Ministry of Health and Family Welfare, New Delhi, India
| | - Kavitha Rajshekar
- Health Technology Assessment in India, Department of Health Research, Ministry of Health and Family Welfare, New Delhi, India
| | - Praveen Vashist
- Community Ophthalmology, Dr. R. P. Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, Ansari Nagar, New Delhi, India
| | - Promila Gupta
- National Programme for Control of Blindness & Visual Impairment, Ministry of Health & Family Welfare, Nirman Bhawan, New Delhi, India
| | - Umang Mathur
- Dr. Shroff’s Charity Eye Hospital, Daryaganj, New Delhi, India
| | - Noopur Gupta
- Community Ophthalmology, Dr. R. P. Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, Ansari Nagar, New Delhi, India
| | - Vivek Gupta
- Community Ophthalmology, Dr. R. P. Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, Ansari Nagar, New Delhi, India
| | - Parul Dutta
- Dr. Shroff’s Charity Eye Hospital, Daryaganj, New Delhi, India
| | - Vijay Kumar Gauba
- Health Technology Assessment in India, Department of Health Research, Ministry of Health and Family Welfare, New Delhi, India
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Manuelle Kleinschnitt-Kataraktchirurgie. SPEKTRUM DER AUGENHEILKUNDE 2020. [DOI: 10.1007/s00717-020-00461-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Dean WH, Murray NL, Buchan JC, Golnik K, Kim MJ, Burton MJ. Ophthalmic Simulated Surgical Competency Assessment Rubric for manual small-incision cataract surgery. J Cataract Refract Surg 2020; 45:1252-1257. [PMID: 31470940 PMCID: PMC6727782 DOI: 10.1016/j.jcrs.2019.04.010] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2019] [Revised: 04/09/2019] [Accepted: 04/10/2019] [Indexed: 11/29/2022]
Abstract
Purpose To develop and test the validity of a surgical competency assessment tool for simulated small-incision cataract surgery (SICS). Setting Participating ophthalmologists contributed from 8 countries. Design Qualitative and quantitative development and evaluation of face and content validity of an assessment rubric, and evaluation of construct validity and reliability. Methods The SICS Ophthalmic Simulated Surgical Competency Assessment Rubric (Sim-OSSCAR) was developed and assessed for face and content validity by an international group of experienced ophthalmologists. Groups of novice and competent surgeons from 4 countries were recorded performing surgery, and masked assessments were performed by 4 expert surgeons, to determine construct validity and reliability. Results The Sim-OSSCAR for SICS was assessed by a panel of 12 international experts from 8 countries. In response to the question, “Do you think the OSSCAR represents the surgical techniques and skills upon which trainees should be assessed?,” all respondents either agreed or strongly agreed. Face validity was rated as 4.60 (out of 5.0). The content was iteratively agreed to by the panel of experts; final content validity was rated as 4.5. Interobserver reliability was assessed, and 17 of 20 items in the assessment matrix had a Krippendorff α correlation of more than 0.6. A Wilcoxon rank-sum test showed that competent surgeons perform better than novices (P = .02). Conclusions This newly developed and validated assessment tool for simulation SICS, based on the International Council of Ophthalmology's Ophthalmology Surgical Competency Assessment Rubric, has good face and content validity. It can play a role in ophthalmic surgical education.
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Affiliation(s)
- William H Dean
- International Centre for Eye Health, London School of Hygiene and Topical Medicine, London, England; Imperial College London, London, England.
| | - Neil L Murray
- Royal Australian and New Zealand College of Ophthalmologists, Sydney, Australia
| | - John C Buchan
- International Centre for Eye Health, London School of Hygiene and Topical Medicine, London, England
| | - Karl Golnik
- International Council of Ophthalmology, San Francisco, California, USA
| | - Min J Kim
- Tropical Epidemiology Group, Faculty of Infectious Disease Epidemiology, London School of Hygiene and Tropical Medicine, London, England
| | - Matthew J Burton
- International Centre for Eye Health, London School of Hygiene and Topical Medicine, London, England; Moorfields Eye Hospital, London, England
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Jiang L, Wan W, Xun Y, Xiong L, Wu B, Xiang Y, Li Z, Zhu L, Ji Y, Yang P, Hu K. Effect of hypothermic perfusion on phacoemulsification in cataract patients complicated with uveitis: a randomised trial. BMC Ophthalmol 2020; 20:232. [PMID: 32546211 PMCID: PMC7298810 DOI: 10.1186/s12886-020-01507-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2020] [Accepted: 06/05/2020] [Indexed: 11/18/2022] Open
Abstract
Background To evaluate the effectiveness and safety of hypothermic perfusion in the phacoemulsification of cataract caused by uveitis. Methods This was a prospective, single-masked, randomised, controlled clinical trial. One hundred and six patients with uveitis-associated cataract underwent phacoemulsification with perfusion fluid temperature at 4 °C (treatment group) or 24 °C (control group). Anterior chamber inflammation grade, corneal endothelial cell count, corneal thickness, macular fovea thickness, and intraocular pressure (IOP) were observed on the 1st day and 7th day after operation. Results The aqueous flare score was 0.83 ± 0.76 in the 4 °C group, which was lower than that in the 24 °C group (1.51 ± 1.02, p = 0.006) on the first day after operation. The aqueous cells score was lower in the 4 °C group (0.17 ± 0.38) than that in the 24 °C group (0.62 ± 0.94, p = 0.025). The mean corneal thickness of incision in the 4 °C group (907.66 ± 85.37 μm) was thinner than that in the 24 °C group (963.75 ± 103.81 μm, p = 0.005). Corneal endothelial cells density, macular fovea thickness, or percentage of transiently increased IOP showed no difference between the two groups (p > 0.05). There was no significant difference in all the main outcome parameters between the two groups on the 7th day after operation (p > 0.05). Conclusions Hypothermic perfusion in the phacoemulsification of uveitis-associated cataract is safe, and it can effectively inhibit anterior chamber inflammation and reduce the incisional corneal edema in the early postoperative stage. Trial registration The study was registered with the Chinese Clinical Trial Registry. (http://www.chictr.org.cn/, Registration Number: ChiCTR1800016145).
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Affiliation(s)
- Lu Jiang
- Chongqing Medical University, Chongqing, China
| | - Wenjuan Wan
- The First Affiliated Hospital of Chongqing Medical University, Chongqing Key Laboratory of Ophthalmology and Chongqing Eye Institute, Chongqing, China
| | - Yan Xun
- Chongqing Medical University, Chongqing, China
| | - Liang Xiong
- Chongqing Medical University, Chongqing, China
| | - Binge Wu
- The Second affiliated hospital of Baotou medical college, Baotou, Inner Mongolia Autonomous Region, China
| | | | - Zhouyu Li
- Chongqing Medical University, Chongqing, China
| | - Lu Zhu
- Chongqing Medical University, Chongqing, China
| | - Yan Ji
- The First Affiliated Hospital of Chongqing Medical University, Chongqing Key Laboratory of Ophthalmology and Chongqing Eye Institute, Chongqing, China
| | - Peizeng Yang
- The First Affiliated Hospital of Chongqing Medical University, Chongqing Key Laboratory of Ophthalmology and Chongqing Eye Institute, Chongqing, China
| | - Ke Hu
- Chongqing Medical University, Chongqing, China. .,The First Affiliated Hospital of Chongqing Medical University, Chongqing Key Laboratory of Ophthalmology and Chongqing Eye Institute, Chongqing, China.
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Pershing S, Lum F, Hsu S, Kelly S, Chiang MF, Rich WL, Parke DW. Endophthalmitis after Cataract Surgery in the United States. Ophthalmology 2020; 127:151-158. [DOI: 10.1016/j.ophtha.2019.08.026] [Citation(s) in RCA: 66] [Impact Index Per Article: 16.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2019] [Revised: 08/13/2019] [Accepted: 08/20/2019] [Indexed: 11/25/2022] Open
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Gogate P. Commentary: Corneal endothelial cell changes in diabetics versus age-group matched nondiabetics after manual small incision cataract surgery (SICS). Indian J Ophthalmol 2019; 68:77. [PMID: 31856473 PMCID: PMC6951204 DOI: 10.4103/ijo.ijo_2196_19] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Affiliation(s)
- Parikshit Gogate
- Department of Ophthalmology, D.Y. Patil Medical College, Pimpri; Community Eye Care Foundation, Dr. Gogate's Eye Clinic, Pune, Maharashtra, India
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Golozar A, Chen Y, Lindsley K, Rouse B, Musch DC, Lum F, Hawkins BS, Li T. Identification and Description of Reliable Evidence for 2016 American Academy of Ophthalmology Preferred Practice Pattern Guidelines for Cataract in the Adult Eye. JAMA Ophthalmol 2019; 136:514-523. [PMID: 29800249 DOI: 10.1001/jamaophthalmol.2018.0786] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
Importance Trustworthy clinical practice guidelines require reliable systematic reviews of the evidence to support recommendations. Since 2016, the American Academy of Ophthalmology (AAO) has partnered with Cochrane Eyes and Vision US Satellite to update their guidelines, the Preferred Practice Patterns (PPP). Objective To describe experiences and findings related to identifying reliable systematic reviews that support topics likely to be addressed in the 2016 update of the 2011 AAO PPP guidelines on cataract in the adult eye. Design, Setting, and Participants Cross-sectional study. Systematic reviews on the management of cataract were searched for in an established database. Each relevant systematic review was mapped to 1 or more of the 24 management categories listed under the Management section of the table of contents of the 2011 AAO PPP guidelines. Data were extracted to determine the reliability of each systematic review using prespecified criteria, and the reliable systematic reviews were examined to find whether they were referenced in the 2016 AAO PPP guidelines. For comparison, we assessed whether the reliable systematic reviews published before February 2010 the last search date of the 2011 AAO PPP guidelines were referenced in the 2011 AAO PPP guidelines. Cochrane Eyes and Vision US Satellite did not provide systematic reviews to the AAO during the development of the 2011 AAO PPP guidelines. Main Outcomes and Measures Systematic review reliability was defined by reporting eligibility criteria, performing a comprehensive literature search, assessing methodologic quality of included studies, using appropriate methods for meta-analysis, and basing conclusions on review findings. Results From 99 systematic reviews on management of cataract, 46 (46%) were classified as reliable. No evidence that a comprehensive search had been conducted was the most common reason a review was classified as unreliable. All 46 reliable systematic reviews were cited in the 2016 AAO PPP guidelines, and 8 of 15 available reliable reviews (53%) were cited in the 2011 PPP guidelines. Conclusions and Relevance The partnership between Cochrane Eyes and Vision US Satellite and the AAO provides the AAO access to an evidence base of relevant and reliable systematic reviews, thereby supporting robust and efficient clinical practice guidelines development to improve the quality of eye care.
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Affiliation(s)
- Asieh Golozar
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - Yujiang Chen
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - Kristina Lindsley
- Department of Epidemiology, Center for Clinical Trials and Evidence Synthesis, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - Benjamin Rouse
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - David C Musch
- Department of Ophthalmology and Visual Sciences, University of Michigan, Ann Arbor.,Department of Epidemiology, University of Michigan, Ann Arbor
| | - Flora Lum
- American Academy of Ophthalmology, San Francisco, California
| | - Barbara S Hawkins
- Department of Epidemiology, Center for Clinical Trials and Evidence Synthesis, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland.,Wilmer Eye Institute, Johns Hopkins University, Baltimore, Maryland
| | - Tianjing Li
- Department of Epidemiology, Center for Clinical Trials and Evidence Synthesis, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
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Mittal R, Peter J, Mani T, David S. Visual outcome and patient satisfaction after cataract surgery: A pragmatic study. CLINICAL EPIDEMIOLOGY AND GLOBAL HEALTH 2019. [DOI: 10.1016/j.cegh.2018.08.008] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022] Open
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Islam MN, Engels T, Hossain S, Sarker M, Rabbani A. Willingness to Pay for Cataract Surgeries Among Patients Visiting Eye Care Facilities in Dhaka, Bangladesh. APPLIED HEALTH ECONOMICS AND HEALTH POLICY 2019; 17:545-554. [PMID: 31065885 DOI: 10.1007/s40258-019-00478-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
BACKGROUND Cataract is the leading cause of avoidable blindness globally. It is estimated that 89% of people with visual impairment live in low- and middle-income countries where the cost of cataract surgery represents a major barrier for accessing these services. Developing self-sustaining healthcare programs to cater the unmet demands warrants a better understanding of patients' willingness to pay (WTP) for their services. OBJECTIVES Using a sample of patients visiting eye care facilities in Dhaka, Bangladesh, we estimate WTP for two different cataract extraction techniques, namely small incision cataract surgery (SICS) and phacoemulsification. METHODS We used contingent valuation (CV) approach and elicited WTP through double-bounded dichotomous choice experiments. We interviewed 556 randomly selected patients (283 for SICS and 273 for phacoemulsification) from five different eye care hospitals of Dhaka. In this paper, we estimated the mean and marginal WTP using interval regression models. We also compared the estimated WTP and stated demand for cataract surgeries against the prevailing market prices of SICS and phacoemulsification. RESULTS We found the mean WTP of BDT 7579 (US$93) for SICS and BDT 10,208 (US$126) for phacoemulsification are equivalent to 12 and 16 days of household income, respectively. Household income and assets appeared as the major determinants of WTP for cataract surgeries. However, we did not find any significant association with gender, occupation, and household size among other socioeconomic characteristics. Comparisons between market prices and average WTP suggest it is possible to have a viable market for SICS, but a subsidy-based model for phacoemulsification will be financially challenging because of low WTP and high costs. CONCLUSION Our findings suggest lower-cost SICS can potentially provide patients access to surgeries to treat cataract conditions. Moreover, price discrimination and cross-subsidization could be a viable strategy to increase the service-uptake as well as ensure financial sustainability.
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Affiliation(s)
- Muhammed Nazmul Islam
- BRAC James P Grant School of Public Health, BRAC University, 68 Shahid Tajuddin Ahmed Avenue, Mohakhali, Dhaka, 1212, Bangladesh.
| | - Thomas Engels
- Sightsavers, 35 Perrymount Road, Haywards Health, West Sussex, RH16 3BW, England, UK
| | - Shafayet Hossain
- BRAC James P Grant School of Public Health, BRAC University, 68 Shahid Tajuddin Ahmed Avenue, Mohakhali, Dhaka, 1212, Bangladesh
| | - Malabika Sarker
- BRAC James P Grant School of Public Health, BRAC University, 68 Shahid Tajuddin Ahmed Avenue, Mohakhali, Dhaka, 1212, Bangladesh
- Institute of Public Health, Heidelberg University, Im Neuenheimer Feld 130.3, 69120, Heidelberg, Germany
| | - Atonu Rabbani
- BRAC James P Grant School of Public Health, BRAC University, 68 Shahid Tajuddin Ahmed Avenue, Mohakhali, Dhaka, 1212, Bangladesh
- Department of Economics, University of Dhaka, Dhaka, 1000, Bangladesh
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Hoshing A. Commentary: Evaluation of complications and visual outcomes in various nucleus delivery techniques of manual small incision cataract surgery. Indian J Ophthalmol 2019; 67:1078-1079. [PMID: 31238415 PMCID: PMC6611267 DOI: 10.4103/ijo.ijo_137_19] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Affiliation(s)
- Abhishek Hoshing
- Senior Consultant, Cornea and Refractive Surgery, Clinical In-Charge, Laxmi Eye Bank, Uran Road, Panvel, Maharashtra, India
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Zafar S, Chen X, Sikder S, Srikumaran D, Woreta FA. Outcomes of resident-performed small incision cataract surgery in a university-based practice in the USA. Clin Ophthalmol 2019; 13:529-534. [PMID: 30962673 PMCID: PMC6433105 DOI: 10.2147/opth.s198870] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/03/2022] Open
Abstract
Purpose To assess outcomes of resident-performed small incision cataract surgery (SICS) at a single academic institute and to determine the availability of SICS-oriented educational resources in residency programs across the USA. Patients and methods A retrospective chart review was conducted on all patients who underwent SICS performed by postgraduate year 4 residents between January 2014 and January 2018 at the Wilmer Eye Institute, Baltimore, MD, USA. Postoperative visual acuity, intraoperative complications, and postoperative complications were the main outcomes measured. In addition, a survey was administered to all ophthalmology residency program directors in the USA to assess the presence of SICS-related content in their surgical training curriculum. Results Twenty-two eyes of 17 patients underwent planned resident-performed SICS, mainly for white cataracts. Intraoperative complications occurred in two (9.1%) eyes. The most common postoperative complication was transient increased intraocular pressure (two eyes, 9.1%). Mean preoperative best-corrected visual acuity (BCVA) was approximately 20/4,000. The large majority (95.2%) of eyes experienced improved BCVA following SICS, with a mean postoperative BCVA of 20/138 over an average follow-up of 4.2 months. Forty-seven programs responded to the survey (40.1% response rate). Residents were trained in SICS in 66.7% of these programs. However, more than half of all the programs did not have SICS-oriented educational resources available for residents. Conclusion Resident-performed SICS was found to be a safe and effective technique for cataract management. Considering the limited surgical volume for SICS in the USA, training programs might instead consider implementing SICS-oriented content in their surgical curriculum, including wet labs.
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Affiliation(s)
- Sidra Zafar
- Wilmer Eye Institute, Johns Hopkins Hospital, Baltimore, MD, USA,
| | - Xinyi Chen
- Wilmer Eye Institute, Johns Hopkins Hospital, Baltimore, MD, USA,
| | - Shameema Sikder
- Wilmer Eye Institute, Johns Hopkins Hospital, Baltimore, MD, USA,
| | - Divya Srikumaran
- Wilmer Eye Institute, Johns Hopkins Hospital, Baltimore, MD, USA,
| | - Fasika A Woreta
- Wilmer Eye Institute, Johns Hopkins Hospital, Baltimore, MD, USA,
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Visual Outcome of Descemet Membrane Endothelial Keratoplasty during the Learning Curve in Initial Fifty Cases. J Ophthalmol 2019; 2019:5921846. [PMID: 31007951 PMCID: PMC6441507 DOI: 10.1155/2019/5921846] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2018] [Revised: 12/11/2018] [Accepted: 01/08/2019] [Indexed: 11/17/2022] Open
Abstract
This study was performed to evaluate the clinical outcomes of the first fifty patients who underwent Descemet membrane endothelial keratoplasty (DMEK) during the 3-month postoperative period and to describe the challenges encountered during the learning curve. In this retrospective study, we reviewed the charts of patients who underwent DMEK. All information regarding patient demographics, indication for surgery, preoperative and postoperative visual acuity at 3 months, donor age, and complications encountered intraoperatively and postoperatively was recorded. Donor endothelial cell count at the time of surgery and during the 3-month follow-up was noted. Data were analyzed using SPSS version 17. Fifty eyes of 49 patients were included in the study with majority being female patients (male : female = 2 : 3). Mean age of patients was 56.8 ± 11.4 years with the age range of 22–78 years. The common indications for DMEK were pseudophakic bullous keratopathy –57.1%, Fuchs endothelial dystrophy-34.7%, failed grafts-6.1% (Descemet stripping endothelial keratoplasty (DSEK) and failed penetrating keratoplasty), and others. Preoperative best spectacle-corrected visual acuity was <20/400 in 88% cases. Postoperative best spectacle-corrected visual acuity at 3 months was >20/63 in 41.8% of the cases, and 93% had visual acuity of 20/200 or better. Donor size was 8 mm, and average donor endothelial cell count (ECC) was 2919 ± 253 cells/mm2. Average ECC at 3 months postoperatively was 1750 ± 664 cells/mm2, which showed a 40% decrease in ECC. The most common encountered complication was graft detachment, which occurred in 16% cases for which rebubbling was done. Regular follow-up and timely identification of graft detachment may prevent the need for retransplantation.
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Han MY, Yu AH, Yuan J, Cai XJ, Ren JB. Effect of anterior capsule polish on visual function: A meta-analysis. PLoS One 2019; 14:e0210205. [PMID: 30620750 PMCID: PMC6324835 DOI: 10.1371/journal.pone.0210205] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2018] [Accepted: 12/18/2018] [Indexed: 01/12/2023] Open
Abstract
PURPOSE To investigate the relationship between anterior capsule polish and visual function. METHODS Data were obtained from Pubmed, Embase, Web of Science, WanFang, VIP and CNKI up to the end of May 2018, without any date or language restrictions for trials. The modified Jadad scale and the newcastle-ottawa scale were used to assess the quality of included studies. Uncorrected visual acuity (UCVA) and posterior capsule opacification (PCO) were used as outcome variables. Data on anterior capsule polish were pooled using weighted, random-effect meta-analysis. RESULTS One randomized controlled trial and 4 observational cohort studies involving 2533 patients were included in the analyses. There was a statistically significant difference of UCVA (OR 1.92, 95% CI 1.41-2.61) between the polish group and the control group, indicating that anterior capsule polish improved UCVA. Further studies with continuous data also suggested that anterior capsule polish was associated with good UCVA (MD 0.11, 95% CI 0.06-0.16). Posterior capsule opacification rate for 1-year or longer follow-up were extracted for 2561 eyes in 3 studies. Posterior capsule opacification rate was lower in the anterior capsule polish group according to summary odds ratio on PCO rate (OR 0.42 95% CI 0.24-0.73). CONCLUSIONS Anterior capsule polish prevents complication of modern cataract surgery and benefits on visual function in short term follow-up period.
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Affiliation(s)
- Meng-yao Han
- Department of Ophthalmology, Zhongnan Hospital of Wuhan University, Wuhan, Hubei, China
| | - Ai-hua Yu
- Department of Ophthalmology, Zhongnan Hospital of Wuhan University, Wuhan, Hubei, China
| | - Jing Yuan
- Department of Ophthalmology, Zhongnan Hospital of Wuhan University, Wuhan, Hubei, China
| | - Xiao-jun Cai
- Department of Ophthalmology, Zhongnan Hospital of Wuhan University, Wuhan, Hubei, China
- * E-mail:
| | - Jiang-bo Ren
- Department of Ophthalmology, Zhongnan Hospital of Wuhan University, Wuhan, Hubei, China
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Pershing S, Henderson VW, Bundorf MK, Lu Y, Rahman M, Andrews CA, Goldstein M, Stein JD. Differences in Cataract Surgery Rates Based on Dementia Status. J Alzheimers Dis 2019; 69:423-432. [PMID: 30958371 PMCID: PMC10728498 DOI: 10.3233/jad-181292] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
BACKGROUND Cataract surgery substantially improves patient quality of life. Despite the rising prevalence of dementia in the US, little is known about use of cataract surgery among this group. OBJECTIVE To evaluate the relationship between dementia status and cataract surgery. METHODS Using administrative insurance claims for a representative sample of 1,125,387 US Medicare beneficiaries who received eye care between 2006 and 2015, we compared cataract surgery rates between patients with and without dementia via multivariable regression models to adjust for patient characteristics. Main outcome measures were annual rates of cataract surgery and hazard ratio and 95% confidence interval (CI) for receiving cataract surgery. RESULTS Cataract surgery was performed in 457,128 patients, 23,331 with a prior diagnosis of dementia. 16.7% of dementia patients underwent cataract surgery, compared to 43.8% of patients without dementia. 59 cataract surgeries were performed per 1000 dementia patients annually, versus 105 surgeries per 1000 nondementia patients. After adjusting for patient characteristics, dementia patients were approximately half as likely to receive cataract surgery compared to nondementia patients (adjusted HR = 0.53, 95% CI 0.53-0.54). Among the subset of patients who received a first cataract surgery, those with dementia were also less likely to receive second-eye cataract surgery (adjusted HR = 0.87, 95% CI 0.86-0.88). CONCLUSION US Medicare patients with dementia are less likely to undergo cataract surgery than those without dementia. This finding has implications for quality of care and dementia progression. More information is necessary to understand why rates of cataract surgery are lower for these patients, and to identify conditions where benefits of surgery may outweigh risks.
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Affiliation(s)
- Suzann Pershing
- Byers Eye Institute at Stanford, Palo Alto, CA, USA
- VA Palo Alto Health Care System, Palo Alto, CA, USA
| | - Victor W. Henderson
- Department of Neurology and Neurological Sciences, Stanford University, Stanford, CA, USA
- Department of Health Research and Policy (Epidemiology), Stanford University, Stanford, CA, USA
| | - M. Kate Bundorf
- Department of Health Research and Policy, Stanford University, Stanford, CA, USA
| | - Ying Lu
- Department of Biomedical Data Science, Stanford University, Stanford, CA, USA
| | - Moshiur Rahman
- Byers Eye Institute at Stanford, Palo Alto, CA, USA
- Department of Ophthalmology and Visual Sciences, University of Michigan, Ann Arbor, MI, USA
- Center for Eye Policy and Innovation, University of Michigan, Ann Arbor, MI, USA
| | - Chris A. Andrews
- Department of Ophthalmology and Visual Sciences, University of Michigan, Ann Arbor, MI, USA
- Center for Eye Policy and Innovation, University of Michigan, Ann Arbor, MI, USA
| | - Mary Goldstein
- VA Palo Alto Health Care System, Palo Alto, CA, USA
- Department of Medicine, Stanford University, Palo Alto, CA, USA
| | - Joshua D. Stein
- Department of Ophthalmology and Visual Sciences, University of Michigan, Ann Arbor, MI, USA
- Center for Eye Policy and Innovation, University of Michigan, Ann Arbor, MI, USA
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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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Ramani S, Pradeep TG, Sundaresh DD. Effect of wet-laboratory training on resident performed manual small-incision cataract surgery. Indian J Ophthalmol 2018; 66:793-797. [PMID: 29785985 PMCID: PMC5989499 DOI: 10.4103/ijo.ijo_1041_17] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Purpose: The aim of this study was to study the effect of wet-laboratory training on the surgical outcome of resident performed manual small-incision cataract surgery (MSICS). Methods: We conducted a retrospective, comparative observational study on resident performed MSICS in our institute. We collected data of 464 patients of which Group A had 232 cases performed by residents without prior wet-laboratory training and Group B had 232 resident performed cases after adequate skill training in the wet laboratory. The demographics, type of cataract, intraoperative, postoperative complications, and immediate visual outcome were compared between the two groups. Results: The age, sex, and type of cataract were similar in both groups of residents. The frequency of intraoperative complications was higher in Group A (23.7%) than in Group B (15.08%) (P = 0.019). The occurrence of posterior capsule (PC) rupture and vitreous loss showed a statistically significant difference, with Group A showing a high rate of 14.3% PC rent and vitreous loss while only 6.9% (P = 0.01) had this complication in Group B. The postoperative visual outcome also was better in Group B than in Group A, with 62.06% of patients in Group B, having a postoperative day 1 vision of better than 6/18 as compared to only 38.36% in Group A. Conclusion: The wet-laboratory training is an effective method of improving the skills of the ophthalmology residents in MSICS. The reduction of complications will improve the quality of surgery and improve the postoperative visual outcome.
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Affiliation(s)
- Soumya Ramani
- Department of Ophthalmology, Ramaiah Medical College, Bengaluru, Karnataka, India
| | | | - Divya D Sundaresh
- Department of Ophthalmology, Ramaiah Medical College, Bengaluru, Karnataka, India
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Amritanand A, Jasper S, Paul P, Kuriakose T. Facilitating factors in overcoming barriers to cataract surgical services among the bilaterally cataract blind in Southern India: A cross-sectional study. Indian J Ophthalmol 2018; 66:963-968. [PMID: 29941740 PMCID: PMC6032741 DOI: 10.4103/ijo.ijo_216_18] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Purpose To effectively address cataract blindness, increasing sight-restoring surgeries among the bilaterally blind are essential. To improve uptake of surgical services among this group, evidence regarding the problems of access is vital. Barriers in accessing eye care services have previously been reported but not specific to bilaterally cataract blind patients. Further, there is a gap in knowledge regarding factors facilitating access to eye care. Our aims were to (1) report proportion of bilaterally cataract blind patients undergoing surgery and sight restoration rate (SRR) and (2) analyze barriers and factors enabling access to eye care services among bilaterally cataract blind patients. Methods Retrospective analysis of interview and clinical data of bilaterally cataract blind patients undergoing surgery through outreach services at the base hospital, from June 2015 to May 2016, was performed. Demographic data, vision, postoperative visual outcomes, barriers, and facilitating factors in accessing cataract surgical services were obtained. Results Bilateral cataract blindness was present in 196/3178 (6.2%, 95% confidence interval 5.4-7.06) patients. SRR was 6.5%. Fear of surgery (24.2%) and lack of family support/escort (22.9%) were the most common barriers. Neighbors and acquaintances (28.6%), general health workers (20.2%), and persons who had undergone cataract surgery (19.6%) were the most common facilitating factors. Conclusion Proportion of bilaterally cataract blind people undergoing surgery and consequently SRR were low. The most common barriers were at the individual level while facilitating factors at the community level were instrumental in promoting uptake of services. Interventions involving community-based support for the blind may be useful in overcoming barriers to eye care.
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Affiliation(s)
- Anika Amritanand
- Department of Ophthalmology, Christian Medical College, Vellore, Tamil Nadu, India
| | - Smitha Jasper
- Department of Ophthalmology, Christian Medical College, Vellore, Tamil Nadu, India
| | - Padma Paul
- Department of Ophthalmology, Christian Medical College, Vellore, Tamil Nadu, India
| | - Thomas Kuriakose
- Department of Ophthalmology, Christian Medical College, Vellore, Tamil Nadu, India
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The role of small incision suture-less cataract surgery in the developed world. Curr Opin Ophthalmol 2018; 29:105-109. [DOI: 10.1097/icu.0000000000000442] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Bhikoo R, Vellara H, Lolokabaira S, Murray N, Sikivou B, McGhee C. Short-term outcomes of small incision cataract surgery provided by a regional population in the Pacific. Clin Exp Ophthalmol 2017; 45:812-819. [DOI: 10.1111/ceo.12965] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2016] [Revised: 03/31/2017] [Accepted: 04/10/2017] [Indexed: 10/19/2022]
Affiliation(s)
- Riyaz Bhikoo
- The Fred Hollows Foundation New Zealand; Auckland New Zealand
- Department of Ophthalmology, New Zealand National Eye Centre; University of Auckland; Auckland New Zealand
| | - Hans Vellara
- Department of Ophthalmology, New Zealand National Eye Centre; University of Auckland; Auckland New Zealand
| | | | - Neil Murray
- The Fred Hollows Foundation New Zealand; Auckland New Zealand
| | - Biu Sikivou
- The Fred Hollows Foundation New Zealand; Auckland New Zealand
- Pacific Eye Institute; Suva Fiji
| | - Charles McGhee
- Department of Ophthalmology, New Zealand National Eye Centre; University of Auckland; Auckland New Zealand
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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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Pawiroredjo JC, Minderhoud J, Mans DRA, Themen HCI, Bueno de Mesquita-Voigt AMT, Siban MR, Forster-Pawiroredjo CM, Moll AC, van Nispen RMA, Limburg H. The cataract situation in Suriname: an effective intervention programme to increase the cataract surgical rate in a developing country. Br J Ophthalmol 2016; 101:89-93. [PMID: 27836828 DOI: 10.1136/bjophthalmol-2016-308659] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2016] [Revised: 09/26/2016] [Accepted: 10/21/2016] [Indexed: 11/03/2022]
Abstract
AIMS To provide an overview of cataract data in Suriname and to describe and evaluate a programme to control cataract blindness in a developing country. DESIGN Evaluation of hospital data and findings from a population-based cross-sectional survey. METHODS The implementation of a new cataract surgical intervention programme was described and retrospectively evaluated by analysing the number of cataract operations and other related indicators at the Suriname Eye Centre (SEC) in the period 2006-2014. Findings of the recent Rapid Assessment of Avoidable Blindness (2013-2014) survey were used to evaluate the national cataract situation in Suriname in people aged ≥50 years (n=2998), including prevalence of cataract blindness, outcome and cataract surgical rate (CSR). RESULTS Since the implementation of a new cataract intervention programme, the number of cataract operations at the SEC has increased from 1150 in 2006 to 4538 in 2014, leading to an estimated national CSR of 9103 per one million inhabitants. The prevalence of bilateral cataract blindness in Suriname was 0.8% (95% CI 0.2% to 1.3%) in individuals aged ≥50 years. The proportion of eyes with a postoperative visual acuity <6/60 (poor outcome) was lowest in eyes operated at the SEC (8.5%) and highest in surgeries performed by foreign humanitarian ophthalmic missions. CONCLUSIONS The cataract situation in Suriname is well under control since the implementation of the new intervention programme. Important factors contributing to this success were the introduction of phacoemulsification, intensive training, and improvement in the affordability and accessibility of cataract surgery. The proportion of poor outcomes was still >5%.
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Affiliation(s)
| | - Janna Minderhoud
- Suriname Eye Centre, Academic Hospital Paramaribo, Paramaribo, Suriname.,Department of Ophthalmology and EMGO+ Institute for Health and Care Research, VU University Medical Centre, Amsterdam, The Netherlands
| | - Dennis R A Mans
- Department of Pharmacology, Faculty of Medical Sciences, Anton de Kom University of Suriname, Paramaribo, Suriname
| | - Herman C I Themen
- Suriname Eye Centre, Academic Hospital Paramaribo, Paramaribo, Suriname
| | | | - Michael R Siban
- Suriname Eye Centre, Academic Hospital Paramaribo, Paramaribo, Suriname
| | | | - Annette C Moll
- Department of Ophthalmology and EMGO+ Institute for Health and Care Research, VU University Medical Centre, Amsterdam, The Netherlands
| | - Ruth M A van Nispen
- Department of Ophthalmology and EMGO+ Institute for Health and Care Research, VU University Medical Centre, Amsterdam, The Netherlands
| | - Hans Limburg
- Health Information Services, Grootebroek, The Netherlands
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Usefulness of surgical complexity classification index in cataract surgery process. ACTA ACUST UNITED AC 2016; 91:281-7. [PMID: 26897332 DOI: 10.1016/j.oftal.2016.01.010] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2015] [Revised: 12/18/2015] [Accepted: 01/04/2016] [Indexed: 11/22/2022]
Abstract
OBJECTIVE To evaluate the usefulness of surgical complexity classification index (SCCI) to predict the degree of surgical difficulty in cataract surgery. MATERIAL AND METHODS This retrospective study includes data collected between January 2013 and December 2014 from patients who underwent cataract extraction by phacoemulsification at our hospital. A sample size of 159 patients was obtained by simple random sampling (P=.5, 10% accuracy, 95% confidence). The main variables were: recording and value of SCCI in electronic medical record (EMR), presence of exfoliation syndrome (XFS), criteria for inclusion in surgical waiting list (SWL), and functional results. SCCI was classified into 7 categories (range: 1-4) according to predictors of technical difficulty, which was indirectly estimated in terms of surgical time (ST). All statistical analyses were performed using SPSS v15.0 statistical software. RESULTS Prevalence of XFS was 18.2% (95%CI: 11.9-24.5). In terms of quality indicators in the cataract surgery process, 96.8% of patients met at least one of the criteria to be included in SWL, and 98.1% gained ≥2 Snellen lines. The SCCI was recorded in EMR of 98.1% patients, and it was grouped for study into 2 categories: High and low surgical complexity. Statistically significant differences in the distribution of ST were found depending on the assigned SCCI (P<.005) and the presence of XFS (P<.005). CONCLUSIONS The SCCI enables to estimate the degree of surgical complexity in terms of ST in cataract surgery, which is especially useful in those areas with high prevalence of XFS, because of the higher theoretical risk of surgical complications.
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