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


Hennig, A; Kumar, J; Yorston, D; Foster, A; (2003) Sutureless cataract surgery with nucleus extraction: outcome of a prospective study in Nepal. The British journal of ophthalmology, 87 (3). pp. 266-270. ISSN 0007-1161 DOI: https://doi.org/10.1136/bjo.87.3.266

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Abstract

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 (51) 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.

Item Type: Article
Keywords: Intraocular-lens, developing-world, blindness, incision, challenges, india, Aged, Astigmatism, etiology, surgery, Cataract, complications, Cataract Extraction, adverse effects, economics, methods, Cornea, anatomy & histology, Costs and Cost Analysis, Female, Human, Lenses, Intraocular, Male, Middle Age, Nepal, Prospective Studies, Treatment Outcome, Visual Acuity, physiology
Faculty and Department: Faculty of Infectious and Tropical Diseases > Dept of Clinical Research
Research Centre: The International Centre for Evidence in Disability
International Centre for Eye Health
PubMed ID: 12598434
Web of Science ID: 181368500006
URI: http://researchonline.lshtm.ac.uk/id/eprint/17370

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