scholarly journals Visual outcome after cataract surgery in a tertiary eye hospital of Chittagong district, Bangladesh

2019 ◽  
Vol 5 (3) ◽  
pp. 212-218
Author(s):  
Jannat Ul Ferdosh ◽  
Mezbah Uddin ◽  
Rajib Husain

To evaluate the visual outcome in patients who have had their cataract surgery in a tertiary hospital of Chittagong district in Bangladesh. This is a clinic-based study of consecutive cataract-operated patients who had age-related cataract with vision less than <6/60 before surgery. A total of 228 patients who visited the hospital and met the eligibility criteria were included in the study. The mean age of the patients was 62.46± 10.14 years and 134 (58.8%) were female. A total of 456 surgeries were performed on 228 patients. The most common procedure was small incision cataract surgery (SICS) with intraocular lens (IOL) implantation, operated in 422(92.5%) eyes. Among cataract-operated eyes, 290 (64%) had presenting vision >6/18 and <6/60 were found in 11 (2.4%) eyes. In most of the cases, visual acuity has improved after best correction as the percentages with the best correction were 402(88%) and 7(1.55%) respectively. Analysis of multiple logistic regression shows that patient’s older age (OR 9.101; 95% CI 3.331, 24.869), gender female (OR 2.374 CI 1.403, 4.017), literacy (OR 1.660; CI 1.009, 2.733) and SICS surgery technique (OR 3.540; CI1.298, 9.659) were significantly associated with poor visual outcome. Overall, this study demonstrates that cataract surgery can restore good visual acuity. However, the visual outcome needs to be improved to meet the WHO standard, and more attention should be directed towards monitoring of outcomes and correction of refractive error after cataract surgery. Asian J. Med. Biol. Res. June 2019, 5(3): 212-218

2020 ◽  
pp. 173-176
Author(s):  
Kinjal Rathod ◽  
Kinjal Trivedi ◽  
Snehal Nayi ◽  
Somesh Aggarwal

Introduction: Cataract is most common cause of curable blindness worldwide and cataract surgery is most common procedure performed in ophthalmology. Posterior capsular opacification (PCO) is most common complication after cataract surgery which is usually treated with Neodymium-doped: Yttrium Garnet (Nd:YAG) laser posterior capsulotomy or occasionally with a surgical capsulotomy. The incidence and severity of PCO correlates to the type of surgical technique, IOL optic edge designs and IOL materials. Material and Methods: 70 eyes of 64 patients operated for age related cataract were studied in this prospective interventional study. Phacoemulsification was done in 35 eyes and SICS in 35 eyes with hydrophobic single piece biconvex foldable intraocular lens. Patients were followed up at 1, 3, 6, 9 and 12 months for the development of PCO. Clinically significant PCO (loss of 2 or more lines of Snellen’s visual acuity chart) was treated with Nd:YAG laser capsulotomy. Results: The overall incidence of PCO was 22.85%. Amongst the patients who developed PCO, SICS and phacoemulsification was performed in 62.5% and 37.5% patients respectively. Result was statistically significant with p value <0.05 using z test. On first postoperative day, patients operated with phacoemulsification had better visual acuity than SICS. Conclusion: Phacoemulsification can provide early and better visual outcome than SICS and has lower incidence of PCO formation which may be due to difference in irrigation and aspiration and less disruption of blood aqueous barrier than SICS. PCO can be reduced by atraumatic surgery and thorough cortical clean up and capsular polishing.


2014 ◽  
Vol 2 (1) ◽  
pp. 22-27
Author(s):  
Md Shafiqul Alam ◽  
Khaleda Nazneen Bari

Background: Age related cataract is the leading cause of blindness and visual impairment throughout the world. With the advent of microsurgical facilities simple cataract extraction surgery has been replaced by small incision cataract surgery (SICS) with posterior chamber intra ocular lens implant, which can be done either with clear corneal incision or scleral incision. Objective: To compare the post operative visual outcome in these two procedures of cataract surgery. Materials and method: This comparative study was carried out in the department of Ophthalmology, Delta Medical College & Hospital, Dhaka, Bangladesh, during the period of January 2010 to December 2012. Total 60 subjects indicated for age related cataract surgery irrespective of sex with the age range of 40-80 years with predefined inclusion and exclusion criteria were enrolled in the study. Subjects were randomly and equally distributed in 2 groups; Group A for SICS with clear corneal incision and group B for SICS with scleral incision. Post operative visual out come was evaluated by determining visual acuity and astigmatism in different occasions and was compared between groups. Statistical analysis was done by SPSS for windows version12. Results: The highest age incidence (43.3%) was found between 61 to 70 years of age group. Among study subjects 40 were male and 20 were female. Preoperative visual acuity and astigmatism were evenly distributed between groups. Regarding postoperative unaided visual outcome, 6/12 or better visual acuity was found in 19.98% cases in group A and 39.6% cases in group B at 1st week. At 6th week 6/6 vision was found in 36.3% in Group A and 56.1% in Group B and 46.2% in group A and 66% in group B without and with correction respectively. With refractive correction, 6/6 vision was attained in 60% subjects of group A and 86.67% of group B at 8th week. Post operative visual acuity was statistically significant in all occasions. Postoperative astigmatism of >0.50D was in 82.5% subjects of group A and 52.8% subjects of group B at 1st week. At 6th week postoperative astigmatism of less than 1D was in 79.95% subjects of Group A and 83.34% subjects of Group B. About 20% subjects in Group A and only 3.3% in Group B showed astigmatism of more than 1D and these differences on both the occasions were statistically significant. Conclusion: The post operative visual outcome was better in SICS with scleral incision (group B) than in SICS with clear corneal incision (Group-A). DOI: http://dx.doi.org/10.3329/dmcj.v2i1.17793 Delta Med Col J. Jan 2014; 2(1): 22-27


2019 ◽  
Vol 11 (2) ◽  
pp. 172-180
Author(s):  
Lagan Paul ◽  
Manisha Agarwal ◽  
Shalini Singh ◽  
Rahul Mayor ◽  
Chanda Gupta ◽  
...  

Objective: To determine the surgical and visual outcomes of posteriorly dislocated lens fragments in the vitreous cavity in patients undergoing cataract surgery. Methods: A total of 149 eyes of 149 patients from 2013 to 2018 were included in the study. The primary cataract surgery was performed either at the base hospital and its peripheral centres or referred from elsewhere. Pars plana vasectomy and nucleus removal was performed along with implantation of intraocular lens, wherever possible. Success was defined as best corrected visual acuity (BCVA) ≥ 6/12 at 3 months follow up. Poor visual outcome was defined as per WHO guidelines as BCVA ≤ 3/60. Results: Posterior capsular rupture and dislocation into vitreous cavity most frequently occurred during phaco-fragmentation in cases of phacoemulsification and during nucleus delivery in cases of small incision cataract surgery. Early vitrectomy was performed within 3 days in 36.2% of cases and within 14 days in 63.8% of cases. Successful visual outcome was achieved in 85.2% of patients at 3 months follow up after vitrectomy. Iatrogenic retinal break occurred in five patients during vitrectomyand five patients had retinal detachment. Poor visual outcome was observed in 12eyes, out of which glaucomatous optic neuropathy seen in 5 cases, cystoid or diabeticmacular edema in 4 cases and age related macular degeneration in 3 cases. Conclusion: Posterior dislocation of lens can be successfully managed in majority of cases with vitreoretinal surgical intervention. The timing of vitrectomy whether performed early or late did not affect the visual outcome. The most important predictorof final visual acuity after PPV for retained lens fragments is a less complicated clinical course without any associated complications such as retinal detachment, cystoidmacula edema and glaucoma. Expertise of the primary cataract surgeon could not be assessed in this study, though surgeon grade with more experience is an important factor in the assessment of complications during the cataract surgery.


2015 ◽  
Vol 10 (1) ◽  
pp. 14-18
Author(s):  
Md Abdullah Al Masum ◽  
Md Kamrul Hasan Khan ◽  
M Anwar Hossain

Introduction: Manual small incision cataract surgery (MSICS) is a cost-effective alternative to phacoemulsification cataract surgery for developing countries. This prospective study was carried out in Combined Military Hospital (CMH), Chittagong from October 2009 to March 2011 on 75 cataract patients who were operated by MSICS technique. Objectives: Aim of this study was to assess the visual outcome and complications of MSICS in a peripheral CMH. Methods: Seventy five cataract patients were operated by MSICS technique. All surgical procedures were performed by the principal author. Major per-operative and postoperative complications were documented. Visual outcome was assessed by Snellen’s visual acuity test 06 weeks after operation. Results: Uncorrected visual acuity (UCVA) was 6/6 – 6/18 in 57 (76.0%) patients, < 6/18 – 6/60 in 15 (20%) and < 6/60 in 03 (4.0%) patients. Best corrected visual acuity (BCVA) was 6/6-6/18 in 65 (86.7%) patients, < 6/18-6/60 in 07 (9.3%) and < 6/60 in 03(4.0%) patients. Visual outcome was good in 86.7% of patients according to World Health Orgnization (WHO) criteria and was not far away from the WHO expected outcome. Posterior capsule rupture was the most significant per-operative complication which was found in 7(9.3%) cases and surgically induced astigmatism was main postoperative complication that affected visual outcome. Mean postoperative astigmatism (against-the rule) was - 1.25DC. 14 JAFMC Bangladesh. Vol 10, No 1 (June) 2014 Conclusion: MSICS is a safe and cost-effective technique of extra-capsular cataract extraction where surgical skill and experience of the surgeon plays a significant role in the result. DOI: http://dx.doi.org/10.3329/jafmc.v10i1.22895 Journal of Armed Forces Medical College Bangladesh Vol.10(1) 2014


1970 ◽  
Vol 1 (2) ◽  
pp. 118-122 ◽  
Author(s):  
P Karki ◽  
JK Shrestha ◽  
JB Shrestha

Introduction: The small-incision cataract surgery is gaining popularity among the ophthalmic surgeons. Objective: To compare the visual outcome of conventional extra-capsular cataract extraction (ECCE) and small-incision cataract surgery (SICS) in a hospital based community cataract program. Materials and methods: A prospective interventional study without randomization was carried out including the patients undergoing cataract surgery by either conventional ECCE or manual SICS. They were followed up for 6 weeks postoperatively. The visual outcomes were compared between the two groups. Statistics: The statistical program Epi-Info version 2000 was used to analyze the data. Mean values with standard deviations, 95% CI and p value were calculated. The p value of <0.05 was considered significant. Results: Of 85 patients, 44 (M: F=10:34) underwent ECCE and 41 (M: F=15:26) SICS (RR= 0.71, 95% CI=0.42-1.2, p value=0.16). Unaided visual acuity on the 1st postoperative day in the ECCE group was e"6/ 18 in 22.7%,<6/18-6/60 in 63.6 %,< 6/60 in 13.7%, whereas in the SICS group, the same was e"6/18 in 70.7%,<6/18-6/60 in 22 %,< 6/60 in 7.3% (95% CI = 0.23 - 0.48, p=0.001). Best corrected visual acuity on the 6th week follow-up in the ECCE group was e"6/18 in 79.5%,<6/18-6/60 in 18.2 %,< 6/60 in 2.3% and in the SICS group the same was 6/18 in 90.5% and <6/18-6/60 in 4.9% (95% CI=0.44 - 0.73; p=0.0012). Conclusion: Both ECCE and SICS are good procedures for hospital based community cataract surgery but within the 6 weeks postoperative period SICS gives better visual outcome. Remarkably higher number of female patients can be provided service in a hospital based community cataract programme as compared to males. Keywords: cataract; small incision; extra-capsular DOI: 10.3126/nepjoph.v1i2.3686 Nep J Oph 2009;1(2):118-122


2017 ◽  
Vol 5 (4) ◽  
pp. 10-19
Author(s):  
P Bastola

Infectious endophthalmitis is among the most serious complications of cataract surgery. Cluster endophthalmitis is defined as five or more cases of endophthalmitis occurring on a particular day in a single operating room in one centre. The study aimed to find out causative organisms, ocular status and visual outcome after an outbreak of cluster endophthalmitis in a high volume cataract surgery in a camp. A descriptive, interventional study was carried out in 18 suspected cases of acute endophthalmitis after manual small incision cataract surgery in a single day. All clinically suspected cases underwent vitreous tap and received intravitreal injections. Vitreous samples were sent for staining and KOH mount, culture, sub-culture and sensitivity test was carried out in all vitreous specimens. Standard treatment protocol was followed. Patients were followed up till six weeks. Of the 89 eyes operated, 18 (20.2%) eyes underwent vitreous tap and intravitreal injections. Mean duration of presentation was 36 hours (24 – 48 hours). Commonest presenting symptom was redness 18 (100%), pain 83.3% (15) followed by decreased vision 77.8% (14). 10 (55.6%) eyes were culture negatives while, 8 (44.4%) were culture positive for pseudomonas aeruginosa. Six (33.3%) eyes needed core vitrectomy and repeat intravitreal injections, whereas 2 (11.1%) eyes needed repeat intravitreal injections only. Eight eyes (44.4%) got a normal visual acuity; two eyes (11.1%) fair and 8 eyes (44.4%) had poor visual acuity according to World Health Organisation (WHO) guidelines. Four eyes (22.2%) needed evisceration, while three (16.7%) eyes progressed to phthisis bulbi. Acute post operative endophthalmitis is a serious complication following cataract surgery. Prognosis of cluster endophthalmitis with proven culture positivity to pseudomonas infection is poor even with prompt standard management.


2011 ◽  
Vol 18 (02) ◽  
pp. 295-299
Author(s):  
MUHAMMAD MUMTAZ CHAUDHRY ◽  
MUHAMMAD MUBASHAR JALIS ◽  
AFZAL KHAN NIAZI

Purpose of study: To find out the prevalence and visual outcome of acute endophthalmitis after cataract surgery. Study Design: Retrospective. Period: 1st January 2001 to 31st December 2009. Setting: Wah Medical College, P.O.F. Hospital Wah Cantt, Rawalpindi. Materials and methods: Fifty cases of acute endophthalmitis who had undergone treatment. Each case of acute endophthalmitis was evaluated in terms of presentation, detailed examination, treatment and outcome. Microbiological culture of the vitreous aspirates was also done to identify the causative organism. The analysis was also meant to identify the prognostic factors of visual outcome of these cases. Results: Fifty patients presented with acute endophthalmitis out of the fifteen thousand cataract surgeries performed during the 9 year period. The incidence of endophthalmitis was 0.33% (95 % CI). A vitreous biopsy with intravitreal injection of antibiotics was done in all the cases presenting with acute endophthalmitis. Decreased visual acuity (90%) and pain (75%) were the main presenting features in these cases.. There were 36 (72%) culture positive cases, with staphylococci (50%) being the most common organism found. Vitreous biopsy yielded positive results in 36 (72%) patients while negative results with no microbial growth was found in 14(28%) patients. There were 20 (40%) growths of coagulase negative staphylococci, 5 (10%) growths of streptococci, 8 (16%) growths of coagulase positive staphylococci, and 3 (6%) of gram negative organisms. The final visual outcome was recorded after one month. 8 (16%) patients achieved 6/12 or better, 26 (52%) patients achieved moderately good visual acuity 6/60 to 6/12, while 16 (32%) patients achieved poor visual acuity of less than 6/60. Of the latter group who had poor visual acuity, 2 (4%) patients had only perception of light while 1 (2%) patient had no perception of light and 1 (2%) patient had blind and painful eye who had to undergo evisceration. 6 (16%) patients achieved 6/12 or better visual acuity. Conclusions: The incidence of endophthalmitis is consistent with other studies. Laboratory diagnosis of the vitreous aspirates helps in the treatment. Achieving a good visual outcome is possible with treatment of the cases of acute endophthalmitis.


Author(s):  
Hazra Soumyadeep ◽  
Saha Tapes Kanti

Background: In developing countries, manual small incision cataract surgery is a better alternative and less expensive in comparison to phacoemulsification and thus the incision is an important factor causing high rates of postoperative astigmatism resulting into poor visual outcome. Thus, modifications to the site of the incision is needed to reduce the pre-existing astigmatism and also to prevent postoperative astigmatism. Modification to superotemporal incision relieves pre-existing astigmatism majorly due to its characteristic of neutralizing against-the-rule astigmatism, which is more prevalent among elderly population and thus improves the visual outcome. Aims: To study the incidence, amount and type of surgically induced astigmatism in superior and superotemporal scleral incision in manual SICS. Methodology: It is a randomized, comparative clinical study done on 100 patients attending the OPD of Ophthalmology at a tertiary care hospital, with senile cataract within a period of one year and underwent manual SICS. 50 of them chosen randomly for superior incision and rest 50 with superotemporal incision. MSICS with PCIOL implantation were performed through unsutured 6.5 mm scleral incision in all. Patients were examined post-operatively on 1st day, 7th day, 2nd week and 4th week and astigmatism was evaluated and compared in both groups. Results: It is seen that on postoperative follow up on 4th week, 77.78% of the patients with ATR astigmatism who underwent superior incision had increased astigmatism whereas, only 13.63% of the patients with ATR astigmatism who underwent supero-temporal incision, had increased astigmatism but 81.82% had decreased ATR astigmatism. However, 77.78% of the patients with preoperative WTR astigmatism who underwent supero-temporal incision, had increased astigmatism, whereas 44.45% of the patients with WTR astigmatism preoperatively, had increased astigmatism in contrast to 50% had decreased amount of astigmatism. It is also seen that the supero-temporal incision group had more number of patients (78%) with visual acuity better than 6/9 at 4th postoperative week than superior incision group (42%). Conclusion: This study concludes that superior incision cause more ATR astigmatism postoperatively whereas superotemporal incision causes lower magnitude of WTR astigmatism, which is advantageous for the elderly. Besides superotemporal incision provides better and early visual acuity postoperatively.


1970 ◽  
Vol 1 (2) ◽  
pp. 95-100 ◽  
Author(s):  
SK Singh ◽  
I Winter ◽  
L Surin

Background: Several studies have shown comparable visual outcomes of SICS and phacoemulsification (Gogate et al 2007, Ruit et al 2007). Objective: To compare the safety and efficacy of different types of surgical procedures (phacoemulsification versus SICS) for cataract surgery in immature cataract. Material and methods: A prospective randomized controlled trial was carried out involving 93 and 89 patients with immature senile cataract selected for phacoemulsification and SICS respectively. Statistics: Mean values with standard deviations were calculated. P value of less than 0.05 was considered significant. Results: There was no difference between the groups in terms of gender, age and pre-operative visual acuity (p = 0.09). In phacoemulsification group (n=93) more than two thirds and in SICS group (n=89) more than three quarters of the patients had good visual outcome (6/6-6/18) on first postoperative day (p=0.065). Poor outcome (<6/60) was recorded in 6% (phacoemulsification group) and 1% (small incision cataract surgery group). Mean visual acuity was 0.43 ± 0.27 in phacoemulsification group and 0.47 ± 0.24 in SICS group. Mean surgery time was significantly shorter in SICS group (p=0.0003). Statistics: Data were computed and analyzed using the SPSS software program vs 10. The p value of < 0.05 was considered significant. Conclusion: There was no significant difference in visual outcome on first post operative day in between phacoemulsification and SICS technique. However, performing SICS was significantly faster. Small incision cataract surgery with implantation of rigid PMMA lens is a suitable surgical technique to treat immature cataract in developing countries. Keywords: phacoemulsification; small incision cataract surgery (SICS) DOI: 10.3126/nepjoph.v1i2.3682 Nep J Oph 2009;1(2):95-100


2019 ◽  
pp. 1-3
Author(s):  
Ritu Agarwal ◽  
Piyush Gupta*

AIM: To evaluate and compare macular thickness changes after uneventful Phacoemulsification and Manual Small Incision Cataract Surgery in correlation with visual acuity. METHOD: Study was conducted on 250 cataract patients they were equally divided into Group A and Group B. Group A patients underwent Phacoemulsification and Group B underwent MSICS. In both groups macular thickness using OCTand Best Corrected Visual Acuity (BCVA) was recorded preoperatively and postoperatively at 1 day, 1, 3, 6 weeks, 3 and 6 months. Macular thickness changes were evaluated and compared with visual acuity. RESULTS: Macular thickness continued to increase from 1 week to 6 months postoperatively which was statistically significant. No correlation found between increased macular thickness and BCVA. CONCLUSION: Increase in macular thickness remained subclinical and there was no impact of increased macular thickness on the final visual outcome.


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