Causes of sub-optimal cataract surgical outcomes in patients presenting to a teaching hospital

Introduction: Surgical treatment for cataract blindness in India is increasing apace; however, sight restoration after surgery is not always satisfactory. Objective: To evaluate visual outcome after cataract surgery and causes of sub-optimal outcome, if any. Materials and methods: A cross-sectional study including the patients who had undergone cataract surgery six months to ten years ago was carried out. The variables studied were visual acuity, demographic and surgical factors and ocular findings. The causes of subnormal outcome was categorized into cataract surgery-related or unrelated. Statistical analysis: SPSS-17 was used; the Chi-square test was used to determine the association between good outcome and categorical variables; the t-test was used for continuous variables. Multivariate analysis using step-wise logistic regression was done. Results: Among 644 patients (644 eyes), good outcome (presenting visual acuity 6/18 or better) after surgery was seen in 266 (41.3 %) eyes. Good outcome was significantly related to urban residence, presence of an intraocular lens and absence of ocular co-morbidities or posterior capsule opacification. Borderline and poor outcomes were mainly due to surgeryrelated causes; treatable causes included uncorrected refractive errors, and posterior capsule opacification. Intra-operative complications resulting in a pulled-up pupil were frequent. Conclusions: Surgical factors are responsible most often for sub-optimal visual outcome; some, like induced astigmatism and vitreous loss, can be modified with training; actively encouraging follow-up visits can allow treatment of residual refractive errors and capsular opacification. DOI: http://dx.doi.org/10.3126/nepjoph.v4i1.5855 NEPJOPH 2012; 4(1): 73-79

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Clinical Study of Visual Outcome and Complications of Nd:YAG Laser Capsulotomy in Posterior Capsular Opacification Following Small Incision Cataract Surgery at a Tertiary Eye Care Centre in Rural Maharashtra - A Prospective Observational Study

Journal of Evidence Based Medicine and Healthcare ◽

10.18410/jebmh/2021/268 ◽

2021 ◽

Vol 8 (19) ◽

pp. 1409-1413

Author(s):

Varsha Ramesh Dhakne ◽

Sourabh Hanumant Karad ◽

Samartha Babasaheb Waghambare ◽

Hanumant Tulshiram Karad ◽

Uttam Haribhau Nisale ◽

...

Keyword(s):

Visual Acuity ◽

Cataract Surgery ◽

Nd:Yag Laser ◽

Visual Outcome ◽

Posterior Capsule Opacification ◽

Posterior Capsule ◽

Posterior Capsular Opacification ◽

Corrected Visual Acuity ◽

Nd:Yag Laser Capsulotomy ◽

Best Corrected Visual Acuity

BACKGROUND Posterior capsule opacification (PCO) is the most common delayed complication of cataract surgery. Nd:YAG (Neodymium yttrium aluminium garnet) laser posterior capsulotomy presents the advantages of a non-invasive, effective, relatively safe technique to manage intact posterior capsule that opacifies postoperatively. With this background we want to study the visual outcome and complications following Nd-YAG laser posterior capsulotomy in posterior capsular opacification following small incision cataract surgery (SICS). METHODS The study includes 64 patients attending outpatient department of a tertiary eye care hospital at Latur from June 2018 to May 2019 who have undergone SICS with PMMA PC IOL (polymethyl methacrylate posterior chamber intraocular lens) implantation and clinically diagnosed with posterior capsular opacification. 64 eyes with PCO were subjected to Nd:YAG laser posterior capsulotomy after detailed slit lamp bio microscopic examination pre- and post-capsulotomy. Follow-up was done at 1 hour, 1 week, 2 weeks and 4 weeks and patients were examined for visual outcome and any complications at each visit. RESULTS There were 16 males (25 %) and 48 females (75 %) with a mean age of 65 years. Posterior capsule opacification occurs within 3 years accounting for 46.9 % of the cases. Elschnig pearls type of PCO was more common when compared to fibrous type of PCO. Best corrected visual acuity (BCVA) before Nd:YAG laser capsulotomy was less than 6 / 60 in 35 patients (54.7 %) and within 6 / 60 to 6 / 24 in 23 patients (35. 9 %) with 6 patients (9.4 %) accounting for visual acuity between 6 / 24 to 6 / 18. After Nd - YAG Laser Capsulotomy, 46.9 % gained best corrected visual acuity of 6 / 18 or better, 39.1 % cases improved 6 / 12 and better and BCVA of 6 / 9, 6 / 6 was observed in 11 cases and 1 case respectively. Only 12 out of 64 patients had complications. Raised intraocular pressure (IOP) was found in 4 patients. Intraocular lens (IOL) pitting was found in 8 patients. CONCLUSIONS Nd:YAG laser capsulotomy is a safe, effective and a non-invasive procedure which avoids all the complications of surgical capsulotomy in patients of posterior capsule opacification. KEYWORDS Posterior capsule opacification (PCO), Nd:Yag Laser Capsulotomy, Best Corrected Visual Acuity (BCVA), Central Subfield Macular Thickness (CSMT)

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Frequency of Complications Following Cataract Surgery in Diabetic Patients at Tertiary Care Hospital

Journal of Gandhara Medical and Dental Science ◽

10.37762/jgmds.9-1.157 ◽

2022 ◽

Vol 9 (1) ◽

pp. 75-81

Author(s):

Muhammad Bilal ◽

Shafqat Ali Shah ◽

Marina Murad ◽

Saad Ali ◽

Ammad Ali ◽

...

Keyword(s):

Visual Acuity ◽

Cataract Surgery ◽

Tertiary Care ◽

Case Series ◽

Female Gender ◽

Posterior Capsule Opacification ◽

Posterior Capsule ◽

Diabetic Patients ◽

Care Hospital ◽

Case Series Study

OBJECTIVES: To determine the frequency of complications following cataract surgery in diabetic patients admitted in the ophthalmology unit. METHODOLOGY: A prospective descriptive interventional case series study was conducted after approval of the ethical committee, from June 2017-June 2020 at the Ophthalmology department MTI-MMC. A total of 129 patients from either gender were enrolled in study. All the study patients went through detailed history and complete ocular examination. After necessary investigations, surgical procedure was carried out. Results were analyzed through the SPSS-24 version. RESULTS: Out of the total 129 eyes of the diabetic patients, fifty-nine (45.7%) were males and seventy (54.3%) were females with a ratio of 1:1.2. Uveitis leads the chart in complications found in twenty (15.50%) eyes while PODR being the least common found in only ten (7.75%) eyes. Worse visual acuity was observed in fourteen (10.85%) eyes. Striate keratopathy and posterior capsule opacification were found in sixteen (12.40%) and fifteen (11.62%) eyes respectively. Among the patients, 15.7% were having more than one complication during follow-up visits and eighty-eight (68.2%) eyes were found to have none complication. The age group 51-60 years observed frequent complications as compared to other groups. Similarly female gender (38.57%) has frequent complications as compared to males (2.7%). CONCLUSION: The study concludes Uveitis as the most common complication observed in 15.50% 0f the eyes while worse visual acuity (10.85%) and progression of diabetic retinopathy (7.75%) being the least common. Striate keratopathy was found in 12.40% while posterior capsule opacification in 11.62% of the eyes.

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Incidence and associated factors of posterior capsule opacification formation in pseudophakic patients at Cipto Mangunkusumo Hospital : January - December 2010

Ophthalmologica Indonesiana ◽

10.35749/journal.v43i1.135 ◽

2019 ◽

Vol 43 (1) ◽

pp. 34

Author(s):

Sita Paramitha Ayuningtyas ◽

Tjahjono D Gondhowiardjo

Keyword(s):

Visual Acuity ◽

Cataract Surgery ◽

Nd:Yag Laser ◽

Cumulative Incidence ◽

Posterior Capsule Opacification ◽

Posterior Capsule ◽

Yttrium Aluminium Garnet ◽

Related Factor ◽

Related Factors ◽

Type Of Surgery

Objective: Posterior capsule opacification (PCO) is the most common postoperative consequence of cataract surgery which may cause visual acuity reduction. The incidence of PCO in Indonesia has not been reported yet. The objectives of this study were to evaluate three years cumulative incidence of PCO and factors associated with PCO formation at Cipto Mangunkusumo (CM) Hospital. Methods: This was a retrospective descriptive study to patients with uneventful senile cataract surgery in year of 2010. All related data were retrieved from those medical records in year of 2013, which included patient demographics, type of surgery, time of PCO stated, IOL characteristics (material, optic edge design and diametere. Best corrected visual acuity (BCVA) pre operatively, when PCO was determined and Nd:YAG laser (Neodymium- doped yttrium aluminium garnet) was performed in decimal. Result: A total of 578 eyes (485 patients) was involved in this study. Three years cumulative incidence of the PCO was 8.82% (51 eyes). Phacoemulsification surgery was conducted in 496 (85.8%) eyes. The median time to PCO was being determined was 21 months (range 1 to 34 months) with the mean of BCVA was 0.50±0.26. Age, gender, and type of surgery had no related factors to PCO, but higher evidence in using of hydrophilic acrylic IOL (10.7%) was found. After laser Nd:YAG laser was performed, BCVA was improved. Conclusion: Three years cumulative incidence of PCO was 8.82% and there was no defined related factor to PCO reformation, but eye had been using hydrophilic acrylic IOL seem to be higher percentage

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Incidence and associated factors of posterior capsule opacification in pseudophakic patients at Cipto Mangunkusumo Hospital

Medical Journal of Indonesia ◽

10.13181/mji.v24i3.1199 ◽

2015 ◽

Vol 24 (3) ◽

pp. 176-82

Author(s):

Sita P. Ayuningtyas ◽

Tjahjono D. Gondhowiardjo

Keyword(s):

Visual Acuity ◽

Cataract Surgery ◽

Nd:Yag Laser ◽

Cumulative Incidence ◽

Yttrium Aluminum Garnet ◽

Posterior Capsule Opacification ◽

Posterior Capsule ◽

Related Data ◽

Included Patient ◽

Hydrophobic Acrylic

Background: Posterior capsule opacification (PCO) is the most common postoperative consequence of cataract surgery which may cause visual acuity reduction, yet the incidence in Indonesia has not been reported. The objectives of this study were to evaluate three years cumulative incidence of PCO and factors associated with PCO formation at Cipto Mangunkusumo Hospital, Jakarta.Methods: This was a retrospective descriptive study on patients with uneventful senile cataract surgery during year 2010. All related data were retrieved from medical records in year 2013, which included patient demographics, type of surgery, intraocular lens (IOL) characteristics (material, optic edge design and diameter). Moreover, time to first PCO diagnosis (month), and best corrected visual acuity (BCVA) pre-operatively, at time PCO was diagnosed and two weeks after Neodymium-doped yttrium aluminum garnet (Nd:YAG) laser were noted (decimal).Results: A total of 578 eyes (485 patients) were involved in this study. Three years cumulative incidence of the PCO was 8.82% (51 eyes). Phacoemulsification surgery was performed in 496 (85.8%) eyes. The median time to PCO diagnosis was 21 months (range 1 to 34 months), mean of BCVA was 0.50 ± 0.26. Age (<65 and >65 years old) was not associated to PCO. Higher incidence of PCO was found in patients using hydrophilic acrylic IOL (10.7%) than in hydrophobic acrylic (6.2%). After Nd:YAG laser was performed, BCVA was improved to 1.00.Conclusion: Three years cumulative incidence of PCO was 8.82% and there was no defined factor related to PCO formation, but higher percentage of PCO occured in patients using hydrophilic acrylic IOL than in hydrophobic acrylic.

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Burden and Factors Associated with Refractive Errors Post Cataract Surgery at Kilimanjaro Christian Medical Center: A Hospital Based Retrospective Cross-sectional Study

Ophthalmology Research An International Journal ◽

10.9734/or/2020/v12i230142 ◽

2020 ◽

pp. 6-16

Author(s):

Livin Uwemeye ◽

William U. Makupa

Keyword(s):

Visual Acuity ◽

Cataract Surgery ◽

Medical Center ◽

Cross Sectional Study ◽

Refractive Errors ◽

Sectional Study ◽

Cross Sectional ◽

Factors Associated ◽

Corrected Visual Acuity ◽

Best Corrected Visual Acuity

Aims: To determine the burden and factors associated with refractive errors after cataract surgery in a training institution. Study Design: A retrospective cross-sectional study. Place and Duration of the Study: Kilimanjaro Christian Medical Center Eye department. Northern Tanzania, from January 2016 to December 2017. Methods: A review of files of all adult patients who have had cataract surgery in 2016 and 2017 was conducted. A total of 626 eyes of 554 patients who had post-operative refraction by experienced optometrists were included. Information were extracted from patients’ files then entered into SPSS version 20 for analysis. The main outcomes were post-operative refraction and best corrected visual acuity. Results: Mean age was 69.3 years (SD=10.7) and ECCE accounted for 76% of surgeries. At least 84.6% had post-operative refractive error and astigmatism was the most common refractive error (56.8%). Spherical error accounted for 27.8%. Spherical error ranged from -12 to 4DS, mean = -0.42 (SD=1.3) DS and median = 0.00DS. The maximum cylindrical error was -7.5 DC, mean = -1.15 (SD=1.36) DC and median = -1.0DC. At least 56% had spherical equivalent within 1D of emmetropia. A BCVA of 6/18 or better was achieved in 92.8%. Age, poor pre-operative VA, poor presenting VA, astigmatism on keratometry, difference between recommended and inserted IOL, ECCE, grade of surgeon and suturing were associated with refractive errors. Conclusion: Refractive errors following cataract surgery are common. Best corrected visual acuity outcome was in normal recommended range; however, the magnitude of refractive errors was high and the proportion of patients who achieved a final refraction within 1D of emmetropia was below the recommended range. An effort should be made to lower the prevalence and magnitude of refractive errors associated with cataract surgery in training institutions.

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Outcomes of manual Small Incision Cataract Surgery (mSICS) compared with phacoemulsification from population based outreach eye camp, in Yogyakarta and Southern Central Java Region, Indonesia

Journal of Community Empowerment for Health ◽

10.22146/jcoemph.36867 ◽

2018 ◽

Vol 1 (1) ◽

Author(s):

Indra Tri Mahayana ◽

Reny Setyowati ◽

Tri Winarti ◽

Suhardjo Prawiroranu

Keyword(s):

Visual Acuity ◽

Adverse Events ◽

Cataract Surgery ◽

Visual Outcome ◽

High Volume ◽

Outreach Program ◽

Small Incision Cataract Surgery ◽

Cross Sectional ◽

Small Incision ◽

Surgical Adverse Events

In this study, we compared the effectiveness (comparison of post-operative visual acuity/VA) of phacoemulsification by ophthalmologists versus manual small incision cataract surgery (mSICS) by residents in a mass cataract surgery setting. This research was a cross-sectional study of 1137 cataract patients who underwent cataract surgery by ophthalmologists and residents in outreach eye camps during 2015-2017 (3 years). There were 554 patients who underwent phacoemulsification by ophthalmologists and 583 patients who underwent mSICS by residents. Basic patient characteristics data, such as: age, sex and pre-surgical VA were recorded and we compared pre- versus post-operative VA (best corrected VA/BCVA) and surgical adverse events in 4 weeks post-operative follow-up. In basic subject characteristics, there were no differences in age and sex between the 2 groups, in which 602 (52.9%) were men and 535 (47.1%) were women. Overall 583 (51.3%) eyes received mSICS and 554 (48,7%) eyes received phacoemulsification. Visual acuity improvement (≥6/18) was achieved in 59.61% of eyes after phacoemulsification and 53.5% eyes after mSICS. There were no statistical differences in visual outcome results between both groups (p=0.10). Severe surgical adverse events (nucleus drop and endophthalmitis) were found in 3 cases (0.26%) and choroidal bleeding in 1 eye (0.08%). The effectiveness of phacoemulsification and mSICS in improving visual acuity was found similar between ophthalmologists and residents. mSICS should be considered for more frequent use in high volume mass cataract surgery.KEYWORDS cataract surgery; phacoemulsification; manual small incision cataract surgery; outreach program; community ophthalmology

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AS-OCT application in quantifying Posterior capsule opacification severity with varied IOL designs

10.21203/rs.3.rs-66210/v1 ◽

2020 ◽

Author(s):

SHASHA YU ◽

Chengzhe Lu ◽

Yawen Guo ◽

Yun Zhao ◽

Xiaoyong Yuan

Keyword(s):

Visual Acuity ◽

Axial Length ◽

Visual Function ◽

Anterior Segment ◽

Posterior Capsule Opacification ◽

Posterior Capsule ◽

Severity Assessment ◽

Cross Sectional ◽

Function Impairment ◽

The Relationship

Abstract Background To evaluate application of AS-OCT in PCO severity assessment and analyse relationship between PCO severity and IOL characters. Methods PCO patients were prospectively recruited. Cross-sectional images of the anterior segment at horizontal and vertical medians were acquired with AS-OCT. The area of the IOL-PC (posterior capsular) space and PCO severity (area, thickness and density at 3 mm and 5 mm IOL optic regions) were measured. The relationship between visual acuity and PCO severity, comparisons of PCO severity and IOL-PC space using varied IOL designs were analysed. Results One hundred PCO eyes were enrolled. IOL-PC space and PCO thickness and area was positively correlated with axial length. The cut-off level of visual acuity: was 0.52 Log MAR. Visual acuity were positively correlated with PCO area and thickness when visual acuity was ≤ 0.52 Log MAR. 3-piece C haptic IOL showed a smaller PCO area and thickness than the 1-piece 3 haptic IOL and 1-piece 4 haptic IOL. PCO area and thickness values for an IOL with a diameter ≤ 11.0 mm were greater than for an IOL with a diameter of 12.5 mm. The differences were statistically significant. PCO area and thickness increased when IOL haptic angulation increased (from 0 to 12 degrees). Conclusions In PCO eyes, cut-off level of visual acuity was 0.52 Log MAR. With more severe PCO, visual acuity maybe not enough to describe the visual function impairment. PCO severity and IOL-PC space was significantly correlated with axial length and IOL design and material.

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Anterior segment OCT application in quantifying posterior capsule opacification severity with varied intraocular lens designs

International Journal of Ophthalmology ◽

10.18240/ijo.2021.09.13 ◽

2021 ◽

Vol 14 (9) ◽

pp. 1384-1391

Author(s):

Sha-Sha Yu ◽

◽

Ya-Wen Guo ◽

Yun Zhao ◽

Xiao-Yong Yuan ◽

...

Keyword(s):

Visual Acuity ◽

Intraocular Lens ◽

Axial Length ◽

Anterior Segment ◽

Posterior Capsule Opacification ◽

Posterior Capsule ◽

Severity Assessment ◽

Cross Sectional ◽

Function Impairment ◽

The Relationship

AIM: To evaluate the application of anterior segment-optical coherence tomography (AS-OCT) in posterior capsule opacification (PCO) severity assessment and analyse the relationship between PCO severity and intraocular lens (IOL) characters. METHODS: PCO patients were prospectively recruited. Cross-sectional images of the anterior segment at horizontal and vertical meridians were acquired with AS-OCT. The area of the IOL-PC (posterior capsular) space and PCO severity (area, thickness, and density at 3 mm and 5 mm IOL optic regions) were measured. The relationship between PCO severity and visual acuity, comparisons of PCO severity and IOL-PC space using varied IOL designs were analysed. RESULTS: One hundred PCO eyes were enrolled. IOL-PC space, PCO thickness and area were positively correlated with axial length. In addition, PCO area and thickness were positively correlated with visual acuity when it was ≤0.52 logMAR. The cut-off level of visual acuity should be 0.52 logMAR. With varied IOL designs, 3-piece C haptic IOL showed a smaller PCO area and thickness than the 1-piece 3 haptic IOL and 1-piece 4 haptic IOL. PCO area and thickness values for an IOL with a diameter ≤11.0 mm was greater than for an IOL with a diameter of 12.5 mm, and the differences were statistically significant. PCO area and thickness increased when IOL haptic angulation increased (from 0 to 12 degrees). CONCLUSION: In PCO eyes, cut-off level of visual acuity is 0.52 logMAR. With more severe PCO, visual acuity maybe not enough to describe the visual function impairment. PCO severity and IOL-PC space are significantly correlated with axial length and IOL design and material.

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Factors affecting the time lag to the second eye cataract surgery in a hospital-based population

Nepalese Journal of Ophthalmology ◽

10.3126/nepjoph.v6i1.10761 ◽

2014 ◽

Vol 6 (1) ◽

pp. 31-38

Author(s):

Charu Malik ◽

Manjit S Bhatia ◽

Upreet Dhaliwal

Keyword(s):

Cataract Surgery ◽

Time Lag ◽

Cross Sectional Study ◽

Analysis Of Covariance ◽

Categorical Variables ◽

Continuous Variables ◽

Chi Square ◽

Cross Sectional ◽

Group 2 ◽

One Year

Introduction: Cataract can be treated successfully, yet patients delay surgery. Surgery in one eye may not promote surgery in the second. Objectives: To determine the time lag to the second eye cataract surgery and identify the factors that affect it. Materials and methods: This study was conducted at an ophthalmology out-patient department of a teaching hospital and was an observational, cross-sectional study. Consecutive patients of over 45 years who had had cataract surgery in one eye and had visually significant senile cataract in the other were categorized into those that requested sequential surgery (Group 1) and those that refused (Group 2). The relevant history and vision were recorded. A questionnaire was used to seek possible responsible factors that determined the refusal for the second surgery. Statistical analysis: Categorical variables were compared between groups using the chi-square test and continuous variables using the Student t-test. Factors significantly affecting the time lag were subjected to the analysis of covariance. Rresults: Of the 250 patients of the study, only 104 (41.6 %) requested the second eye surgery, less than one-fifth within one year. Thirteen patients from Group 2 presented with complications of hypermaturity in the second eye. The average time lag was 2.39 ± 2.19 years. It was significantly more in Group 2 patients (p = 0.024) who also reported more barriers (2.75 ± 1.23 versus 1.58 ± 1.10; p = 0.005). The factors that increased the time lag were older age (p = 0.028), extra-capsular surgery (p < 0.001), and being able to manage after the first surgery (p = 0.011) in Group1, and eye-camp (p = 0.021) or extra-capsular surgery (p < 0.001) in Group 2 patients. Conclusions: One-fifth of the patients reported back for sequential surgery within one year. Patients who refused surgery had more barriers; most were related to the first surgery and should be anticipated by compassionate ophthalmic professionals after surgery in the first eye. DOI: http://dx.doi.org/10.3126/nepjoph.v6i1.10761 Nepal J Ophthalmol 2014; 6 (2): 31-38

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Astigmatism Correction in Cataract Surgery with Foldable Toric IOL

MVP Journal of Medical Sciences ◽

10.18311/mvpjms/2014/v1/i2/824 ◽

2014 ◽

Vol 1 (2) ◽

pp. 93

Author(s):

Mrunal Suresh Patil ◽

Dhiraj Namdeo Balwir ◽

Sonal Dua ◽

Swapnil Shivaji Vidhate

Keyword(s):

Visual Acuity ◽

Statistical Analysis ◽

Cataract Surgery ◽

Categorical Variables ◽

P Value ◽

Continuous Variables ◽

Toric Iol ◽

Iol Implantation ◽

Astigmatism Correction ◽

Significant Difference

Aim: To evaluate correction of pre-existing astigmatism after foldable Toric IOL implantation in patients undergoing cataract surgery.Materal & Methods: In this prospective observational study we included 10 eyes of 10 patients with astigmatism between 2.00D to 6.00D &undergoing cataract surgery. Phacoemulsification was performed with Toric IOL implantation through 2.8mm clear corneal temporal incision. Patients were examined post operatively for Uncorrected Visual Acuity (UCVA), Best Corrected Visual Acuity (BCVA) & residual refractive astigmatism.Statistical Analysis: Statistical analysis was performed by the SPSS program for Windows, ver.16.0.Continuous variables are expressed as mean ± SD, and categorical variables are presented as absolute numbers and percentage. For the statistical test, a p value less than 0.05 was taken to indicate a significant difference.Results: The UCVA was 6/9 or better in 90% of eyes. 80% eyes achieved 6/6 BCVA. The mean refractive cylinder corrected from -3.4 ± 1.4 D to -0.60 ± 0.27 D which was statistically significant. (p value=0.0001).Conclusion: Toric IOL implantation is an effective, safe surgical option to manage pre-existing corneal astigmatism during cataract surgery.

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