Results in comparison between 30 gauge ultrathin wall and 27 gauge needle in sutureless intraocular lens flanged technique in diabetic patients: 24-month follow-up study

AIMS

Intraoperative complications in cataract surgery are more common in diabetic patients. Solving aphakia in these circumstances remains a challenge, as the scleral structure has been shown to be different in diabetes. This study aims to analyze the role of a secondary sutureless scleral intraocular lens (IOL) flanged fixation in diabetic patients without capsular support and to compare the anatomical and functional outcomes using a 30 gauge (G) ultrathin wall needle vs. a 27G needle.

METHODS

Retrospective, observational cohort study. 105 eyes (105 patients) who underwent PPV with secondary IOL fixation using a sutureless 27G (n = 51) or a 30G ultrathin wall (UTW) needle technique (n = 54) and had a 24 months postoperative follow up. Consecutive patients' records were reviewed for lens stability and centration parameters, intra- and postoperative complications at 7 days, 1, 3, 6, 12, and 24 months after surgery. Correlations between outcome measures and needle size (27G vs. 30G UTW) were analyzed.

RESULTS

IOL displacement occurred in 30 patients (41.2%) in the 27G group and did not occur in the 30G UTW needle group (p < 0.001). Mean time until IOL displacement was 10.5 ± 7.0 months (range: 7 days-24 months). IOL centricity was significantly better in the 30G ultrathin wall needle group compared to 27 G (p = 0.001). Additional surgical interventions were necessary only in the 27G group (n = 14).

CONCLUSIONS

Sutureless IOL flanged technique using a 30G UTW needle is more predictable and has less complications in aphakic diabetic patients, compared to a 27G needle technique.

Scleral Fixation of Intraocular Lens with Ab Interno Technique

INTRODUCTION

Implantation of scleral fixation intraocular lens for the surgical management of aphakia cases without capsular support is a safe procedure.

METHODS

Prospective study was carried out at Lumbini Eye Institute, Bhairahawa. A total of 32 patients underwent scleral fixation intraocular lens implantation within a period of two years from February 2014 to February 2016.

RESULTS

The age range was from 15 to 79 years; mean age was 47.56 ± 20.16 SD. Among them 14 (43.75%) were male and 18 (56.25%) were female. The follow-up lasted for 24 months.

CONCLUSIONS

SFIOL for the surgical management of aphakia in the absence of capsular support is a safe procedure. The long-term follow-up is needed for an accurate evaluation of outcomes.

National surveys of avoidable blindness and visual impairment in Argentina, El Salvador, Honduras, Panama, Peru, and Uruguay

OBJECTIVE

Describe the rationale and methodology of the Rapid Assessment of Avoidable Blindness applied in surveys at the national level in 2011-2013 in Argentina, El Salvador, Honduras, Panama, Peru, and Uruguay.

METHODS

The survey includes individuals aged 50 years and older, minimizing required sample sizes, which vary from 2 000 to 5 000 people. It uses straightforward sampling and examination techniques, and data analysis is automatic and does not require a statistician. It is relatively inexpensive, as it does not take a long time, does not require expensive ophthalmic equipment, and can be carried out by local staff. Reports are generated by the assessment software package.

RESULTS

Indicators measured are prevalence of blindness and of moderate and severe visual impairment (broken down into avoidable causes and cataracts); prevalence of aphakia or pseudophakia; cataract surgical coverage; visual outcome of cataract surgeries; causes of poor outcomes; access barriers to cataract surgery; and cataract surgery service indicators. Results of each survey will be published sequentially in successive issues of the Journal, and a final summary article will analyze results as a whole and in comparison with the other surveys in this group and with those previously published, which will provide a current picture of the situation in this group of countries.

CONCLUSIONS

The Rapid Assessment of Avoidable Blindness is a robust, simple, and inexpensive methodology to determine prevalence of blindness and visual impairment as well as eye health service coverage and quality. It is a very valuable tool for measuring progress by blindness prevention programs and their impact on the population.

Rapid assessment of avoidable blindness in Uruguay: results of a nationwide survey

OBJECTIVE

To investigate and describe the prevalence and causes of blindness and moderate and severe visual impairment in older adults living in Uruguay.

METHODS

All individuals aged ≥ 50 years old living in randomly selected clusters were eligible to participate. In each census enumeration unit selected, 50 residents aged 50 years and older were chosen to participate in the study using compact segment sampling. The study participants underwent visual acuity (VA) measurement and lens examination; those with presenting VA (PVA) < 20/60 also underwent direct ophthalmoscopy. Moderate visual impairment (MVI) was defined as PVA < 20/60-20/200, severe visual impairment (SVI) was defined as PVA < 20/200-20/400, and blindness was defined as PVA < 20/400, all based on vision in the better eye with available correction.

RESULTS

Out of 3 956 eligible individuals, 3 729 (94.3%) were examined. The age- and sex-adjusted prevalence of blindness was 0.9% (95% confidence interval (CI): 0.5-1.3). Cataract (48.6%) and glaucoma (14.3%) were the main causes of blindness. Prevalence of SVI and MVI was 0.9% (95% CI: 0.5-1.3) and 7.9% (95% CI: 6.0-9.7) respectively. Cataract was the main cause of SVI (65.7%), followed by uncorrected refractive error (14.3%), which was the main cause of MVI (55.2%). Cataract surgical coverage was 76.8% (calculated by eye) and 91.3% (calculated by individual). Of all eyes operated for cataract, 70.0% could see ≥ 20/60 and 15.3% could not see 20/200 post-surgery.

CONCLUSIONS

Prevalence of blindness in Uruguay is low compared to other Latin American countries, but further reduction is feasible. Due to Uruguay's high cataract surgical coverage and growing proportion of people ≥ 50 years old, the impact of posterior pole diseases as a contributing factor to blindness might increase in future.

Prevalence of ocular disease and blindness in a rural area in the eastern region of Iceland during 1980 through 1984

The main emphasis in this study is on the three most common potentially blinding diseases in the age group 43 years and older, i.e. cataract, age related macular degeneration and open angle glaucoma. The prevalence of all three diseases increases with advancing age (P less than 0.001, corr. greater than 0.8). In the age group 63 years and older there is a statistically significant difference in the occurrence of cataracts between females and males (P less than 0.02). Females outnumber males and the former appear to develop cataract at an earlier age than men. Among persons 73 years of age and older there is a statistically significant difference in the occurrence of open angle glaucoma between males and females (P less than 0.05), whereby males outnumbered females. Persons with age related macular degeneration were divided into an exudative group and an atrophic group. There was no sex difference in the atrophic group, whereas females outnumber males by 2:1 in the exudative group, which is mainly accounted for by overrepresentation of females 83 years and older. Persons 83 years and older who had age related macular degeneration also had cataracts in all instances and open angle glaucoma in 23.8% of cases. Sixteen persons were legally blind i.e. had visual acuity less than or equal to 6/60 in the better eye or visual field less than 10 degrees in the better eye. Eight persons thereof, were greater than or equal to 83 years of age.

Cataract surgery and the primary care practitioner

Cataract surgery with intraocular lens implantation is the most frequently performed operation in the Medicare Part B population. Such patients will seek the advice of their primary care practitioner, and the safety of the procedure may depend on the information the practitioner provides to the surgeon and anesthesia team. This article reviews pertinent issues surrounding the decision to operate; how various intraocular lens implants are selected; how surgery is now performed; postoperative complications, activities, and care; the role of the primary care physician; and the issue of medical clearance for this procedure.

Changing pattern of childhood blindness in Maharashtra, India

AIM

To determine the causes of severe visual impairment and blindness in children in schools for the blind in Maharashtra, India.

METHODS

Children aged <16 years with a visual acuity of <6/60 in the better eye, attending 35 schools for the blind were examined between 2002 and 2005, and causes were classified using the World Health Organization's system.

RESULTS

1985 students were examined, 1778 of whom fulfilled the eligibility criteria. The major causes of visual loss were congenital anomalies (microphthalmos or anophthalmos; 735, 41.3%), corneal conditions (mainly scarring; 395, 22.2%), cataract or aphakia (n = 107, 6%), and retinal disorders (mainly dystrophies; n = 199, 11.2%). More than one third of children (34.5%) were blind from conditions which could have been prevented or treated, 139 of whom were referred for surgery. Low vision devices improved near-acuity in 79 (4.4%) children, and 72 (4%) benefited from refraction. No variation in causes by sex or region was observed.

CONCLUSIONS

Congenital anomalies accounted for 41% of blindness, which is higher than in a similar study conducted 10 years ago. Corneal scarring seems to be declining in importance, low vision and optical services need to be improved, and research is needed to determine the aetiology of congenital anomalies.

Glaucoma in aphakia and pseudophakia in the Chennai Glaucoma Study

AIM

To determine the prevalence of glaucoma among aphakes and pseudophakes in a rural population of southern India.

METHODS

3924 subjects aged 40 years or above underwent complete ophthalmic examination. Glaucoma in aphakia/pseudophakia was diagnosed using International Society of Geographical and Epidemiological Ophthalmology criteria in aphakic/pseudophakic people.

RESULTS

54 subjects (37 aphakes, 17 pseudophakes) (1.38% of 3924 subjects, 11.2% of 482 aphakes/pseudophakes) had glaucoma in aphakia/pseudophakia. Aphakia, age, intraocular pressure (IOP), pseudoexfoliation, and peripheral anterior synechiae greater than or equal to 180 degrees of the angle were risk factors for glaucoma on univariate analysis. On multivariate analysis, IOP and aphakia were independent risk factors for glaucoma. 39 people (72.22%) with glaucoma had normal IOP at presentation. None of the people with glaucoma were aware of the disease. Blindness in one or both eyes was seen in 12 subjects (10 unilateral and two bilateral)-that is, 22.22% of people with glaucoma in aphakia/pseudophakia.

CONCLUSIONS

Glaucoma is an important cause of ocular morbidity among aphakes and pseudophakes in this rural population of south India. This glaucoma, responsible for unilateral or bilateral blindness in 22.2% of those affected, was entirely undetected in this study population.

Cataract surgical coverage and outcome in the Tibet Autonomous Region of China

BACKGROUND

A recently published, population based survey of the Tibet Autonomous Region (TAR) of China reported on low vision, blindness, and blinding conditions. This paper presents detailed findings from that survey regarding cataract, including prevalence, cataract surgical coverage, surgical outcome, and barriers to use of services.

METHODS

The Tibet Eye Care Assessment (TECA) was a prevalence survey of people from randomly selected households from three of the seven provinces of the TAR (Lhoka, Nakchu, and Lingzhr), representing its three main environmental regions. The survey, conducted in 1999 and 2000, assessed visual acuity, cause of vision loss, and eye care services.

RESULTS

Among the 15,900 people enumerated, 12,644 were examined (79.6%). Cataract prevalence was 5.2% and 13.8%, for the total population, and those over age 50, respectively. Cataract surgical coverage (vision <6/60) for people age 50 and older (85-90% of cataract blind) was 56% overall, 70% for men and 47% for women. The most common barriers to use of cataract surgical services were distance and cost. In the 216 eyes with cataract surgery, 60% were aphakic and 40% were pseudophakic. Pseudophakic surgery left 19% of eyes blind (<6/60) and an additional 20% of eyes with poor vision (6/24-6/60). Aphakic surgery left 24% of eyes blind and an additional 21% of eyes with poor vision. Even though more women remained blind than men, 28% versus 18% respectively, the different was not statistically significant (p = 0.25).

CONCLUSIONS

Cataract surgical coverage was remarkably high despite the difficulty of providing services to such an isolated and sparse population. Cataract surgical outcome was poor for both aphakic and pseudophakic surgery. Two main priorities are improving cataract surgical quality and cataract surgical coverage, particularly for women.

The prevalence of eye disease in Leicester: a comparison of adults of Asian and European descent

Random samples of people aged 40 years and over were drawn from lists of patients registered with two neighbouring inner-city general practices: one predominantly with Asian patients and the other predominantly with European patients. The people selected were invited to attend specially arranged eye clinics for examination by an ophthalmologist and an optician. We examined 377 people and found that, compared to people of European descent, Asians had a significantly higher prevalence of age-related cataract: 30% compared to 3% in people aged under 60 years and 78% compared to 54% in those aged 60 years and over. The age of onset of cataract seems to be earlier in Asians. After adjustment for age, there were no statistically significant ethnic differences in the prevalences of open-angle glaucoma, macular degeneration or diabetic retinopathy.

Distinctive cataract in the Stickler syndrome

We determined the clinical characteristics of cataract in 133 patients with the Stickler syndrome. Cataracts of various types or aphakia were found in 115 of 231 eyes (49.8%) studied. The most frequent and distinctive lesions, described as wedge and fleck cataracts, accounted for 40 of the 93 cataracts (43.0%) observed. These distinctive opacities may serve as a clinical marker for the Stickler syndrome and facilitate early diagnosis.

Rapid epidemiologic assessment of cataract blindness. The Aravind Rapid Epidemiologic Assessment Staff

A major constraint to obtaining reliable information about blindness and its causes in developing countries is the limited availability of ophthalmologists for diagnosis in population-based surveys. This study in rural south India assessed the feasibility of using non-ophthalmologists to make diagnoses in a population-based survey. Ten men in their early twenties with 12 years of schooling were recruited and trained as ophthalmic assistants through a six week course in basic ophthalmology. All people aged 40 and older in households in 24 villages were enumerated and invited to have an eye examination. At a central site, 1309 subjects were independently examined by an ophthalmologist and two different ophthalmic assistants. Ophthalmic assistant cataract diagnosis is both sensitive and specific relative to the ophthalmologist's diagnosis. Sensitivity and specificity estimates were used to adjust prevalence estimates obtained from ophthalmic assistant examinations conducted at the central site as well as at the doorstep of sample households. The findings indicate that epidemiologic assessment of cataract blindness can be completed using non-ophthalmologists to diagnose cataract.

The incidence of retinal detachment in Rochester, Minnesota, 1970-1978

We studied the incidence of rhegmatogenous retinal detachment in Rochester, Minnesota, for the nine-year period from 1970 through 1978. The age-adjusted rate for idiopathic rhegmatogenous retinal detachment was 10.1 per 100,000 population per year (45 cases). Including 12 cases of aphakic retinal detachments, the age-adjusted incidence was 12.9 per 100,000 population per year. Not surprisingly, the incidence rate increased with age in both sexes. By extrapolation from the Rochester rates, the number of cases per year of idiopathic retinal detachment in the United States would be expected to be about 22,000, and the number of both aphakic and idiopathic phakic cases per year would be expected to approach 28,000.

Rhegmatogenous retinal detachment without macular involvement treated with scleral buckling

Among 173 patients who had rhegmatogenous retinal detachment with spared maculas, high percentage achieved anatomic and functional success. We reattached 171 (99%) of the retinas; 150 (76%) of the eyes had final visual acuities of 6/15 (20/50) or better. Eighteen eyes (10%) had final postoperative visual acuities reduced more than two lines from the preoperative level. This reduced visual acuity was primarily related to postoperative changes occurring in the macula. The prognosis both for anatomic reattachment and visual acuity after scleral buckling for rhegmatogenous retinal detachment is significantly better when the macula is spared than when it is not. Large numbers of cryoapplications were not associated with macular complications.