WORLD VIEW

Sutureless cataract surgery with nucleus extraction: outcome of a prospective study in Nepal

A Hennig¹, J Kumar¹, D Yorston² and A Foster³

Series editors: W V Good and S Ruit

¹ Lahan Eye Hospital, Nepal
² Moorfields Eye Hospital, London, UK
³ London School of Hygiene and Tropical Medicine, London, UK

Correspondence to:
Correspondence to:
Dr Albrecht Hennig, Lahan Eye Hospital, Nepal;
ahennig{at}mos.com.np

Aim: To report the short and medium term outcome of a prospective series of sutureless manual extracapsular cataract extractions (ECCE) at a high volume surgical centre in Nepal.

Methods: Cataract surgery was carried out, on eyes with no co-existing diseases, in 500 consecutive patients who were likely to return for follow up. The technique involved sclerocorneal tunnel, capsulotomy, hydrodissection, nucleus extraction with a bent needle tip hook, and posterior chamber intraocular lens (PC-IOL) implantation according to biometry findings. Surgical complications, visual acuity at discharge, 6 weeks, and 1 year follow up, and surgically induced astigmatism are reported.

Results: The uncorrected visual acuity at discharge was 6/18 or better in 76.8% of eyes, and declined to 70.5% at 6 weeks’ follow up, and 64.9% at 1 year. The best corrected visual acuity was 6/18 or better in 96.2% of eyes at 6 weeks and in 95.9% at 1 year. Poor visual outcome (<6/60) occurred in less than 2%. Intraoperative complications included 47 (9.4%) eyes with hyphaema, and one eye (0.2%) with posterior capsule rupture and vitreous in the anterior chamber. Surgery led to an increase in against the rule astigmatism, which was the major cause of uncorrected visual acuity less than 6/18. Six weeks postoperatively, 85.5% of eyes had against the rule astigmatism, with a mean induced cylinder of 1.41 D (SD 0.8). There was a further small increase in against the rule astigmatism of 0.66 D (SD 0.41) between 6 weeks and 1 year. The mean duration of surgery was 4 minutes and the average cost of consumables, including the IOL, was less than $10.

Conclusion: Rapid recovery of good vision can be achieved with sutureless manual ECCE at low cost in areas where there is a need for high volume cataract surgery. Further work is required to reduce significant postoperative astigmatism, which was the major cause of uncorrected acuity less than 6/18.

Keywords: cataract surgery; extracapsular cataract extraction; Nepal; astigmatism

CiteULike    Complore    Connotea    Del.icio.us    Digg    Reddit    Technorati    What's this?

Relevant Article

BJO at a glance

Creig Hoyt
Br. J. Ophthalmol. 2003 87: 253. [Extract] [Full Text] [PDF]

This article has been cited by other articles:

• Dua, H. S, Said, D. G, Otri, A. M. (2009). Are we doing too many cataract operations? Cataract surgery: a global perspective. Br. J. Ophthalmol. 93: 1-2 [Full Text]  
• Lam, D. S. C., Congdon, N. G., Rao, S. K., Fan, H., Liu, Y., Zhang, L., Lin, X., Choi, K., Zheng, Z., Huang, W., Zhou, Z., Pang, C. P. (2007). Visual Outcomes and Astigmatism After Sutureless, Manual Cataract Extraction in Rural China: Study of Cataract Outcomes and Up-Take of Services (SCOUTS) in the Caring Is Hip Project, Report 1. Arch Ophthalmol 125: 1539-1544 [Abstract] [Full Text]  
• Chang, D F (2005). Tackling the greatest challenge in cataract surgery. Br. J. Ophthalmol. 89: 1073-1077 [Full Text]  
• Venkatesh, R, Muralikrishnan, R, Balent, L. C., Prakash, S K., Prajna, N V. (2005). Outcomes of high volume cataract surgeries in a developing country. Br. J. Ophthalmol. 89: 1079-1083 [Abstract] [Full Text]  

eLetters:

Read all eLetters

Sutureless surgery in Maharastra, India

Jayant P Shah

BJO Online, 25 Mar 2003 [Full text]