Outcome of extra-capsular cataract extraction with posterior chamber intraocular lens implantation performed at a cataract surgical campaign

Background: Cataract is the leading cause of blindness and visual impairment in many developing countries. It accounts for 20 million bilaterally blind people worldwide. Objectives : This study was conducted to evaluate the visual outcome, complications and patients' satisfaction during a cataract surgical campaign. Methods : Patients who participated in the cataract surgical campaign from and who had ECCE with PC IOL insertion done were included in the study. Three expatriate ophthalmic surgeons using similar surgical techniques operated all patients. Follow up was done on the first postoperative day, and fourth and eighth week. Results : Of the 214 patients who had ECCE with PC IOL done 174 (81.3%) were followed for the whole eight weeks. The final corrected visual acuity was 6/18 or better in 109(63.4%) of patients and less than 6/18 in 65(37%) of patients. Of the 68 preoperatively bilaterally blind people (VA less than 3/60 in the better eye) 57(83.8%) had final corrected VA of greater or equal to 6/60. 84 (48.3 %) of patients said they have very much improved vision and another 84 (48.3 %) of patients said they had better vision than the preoperative state. Only 3.4 % said their vision remained the same or worsened. Conclusions : The visual outcome of the cataract surgical campaign was gratifying both from the patients' and physician's point of view. The study showed that eye camp surgeries involving ECCE with PC IOL are feasible in African settings. We recommend that future cataract surgical campaigns should consider using ECCE with PC IOL insertion as their surgical procedure. [Ethiop. J. Health Dev. 2002;16(1):77-83] Introduction The current global estimate indicates that blindness affects close to 45 million people with 9 out of 10 living in developing countries (1). Cataract is the leading cause of blindness and visual impairment in many developing nations, leading to bilateral blindness in an estimated 20 million people worldwide (2,3,4,5). In sub-Saharan Africa 3.5 million people are believed to be blind from cataract. And as the population grows and ages, this figure is likely to increase (6,7,8). In Ethiopia blindness is estimated to affect 1.5 % of the total population. The pathogenesis of this disease is believed to be multifactorial and is not completely understood up to now (9,10). The majority of cases of cataract are age related (11,12,13) and causes bilateral visual impairment. Other important causes of cataract also include drug induced, trauma, metabolic disorders and nutritional diseases (14). Even though lots of medical treatment for cataract have been studied and many treatment modalities are described (9,10) there is no medical treatment that has definitely been proven to delay, prevent or reverse the development of cataract in adults. Currently, therefore, the only treatment available for cataract is surgery. _______________________________________ Department of Ophthalmology, Faculty of Medicine, Addis Ababa university, P.O. Box 9086 Addis Ababa Outcome of extra-capsular cataract extraction 2 -----------------------------------------------------------The surgical treatment of cataract is an ancient art that spans two millennia. Surgeons in ancient India practiced couching as early as 800 BC (14). Couching is the technique of pushing the white opacity downwards and backwards using a needle. In modern times there are two basic ways for the removal of cataract. One is intracapsular cataract extraction (ICCE), which is the complete removal of the cataractous lens with its capsule. The other is extracapsular cataract extraction (ECCE), which can be supplemented with posterior chamber (PC) intraocular lens (IOL) implantation (14,15). Currently the later is the preferred technique. Eye camp cataract surgery has been carried out in Ethiopia previously and ICCE was the method used in most cases. Detailed report on the outcome of cataract surgery in these campaigns has not been made. This study was conducted to evaluate the visual outcome, complications and patients' satisfaction of ECCE with PC IOL insertion done during a cataract surgical campaign carried out at Menelik II Hospital. Methods This study was conducted at the Department of Ophthalmology, Menelik II Hospital between October 9 and 13, 1999. During this period cataract surgical campaign, which was sponsored by Rotary Club, was carried out at Menelik II Hospital. The source population was all patients who came for operation during the "cataract surgery campaign" after an announcement through the mass media. All patients who came to the hospital for visual problem during this time were examined for ocular and systemic diseases by ophthal-mologists and ophthalmology residents. Only patients with mature cataract in one or both eyes were considered for operation. Cases who, in addition to cataract, had other ocular diseases such as glaucoma, external infections, and trichiasis or entropion were excluded. Those patients with untreated or uncontrolled systemic illness such as hypertension or diabetes Mellitus were also excluded from being operated. Therefore, the study popu-lation was those patients who underwent cataract surgery with posterior chamber intraocular lens implantation (ECCE with PC IOL) during this campaign. Patients were informed about the need for a prolonged follow up after surgery. Three expatriate ophthalmic surgeons per-formed all the operations. The surgical technique used was basically the same for all the surgeons. The operation routine was as follows. Peribulbar anesthesia was given including Bupivacaine 2cc, Lidocaine 3 cc and hyaluronidase. Pressure was applied to the globe for 10-15 minutes with a ball. Instruments were either sterilized in an autoclave or soaked in a sterilizing solution. After limbal incision, continuous curvilinear capsulorexis (CCC) was done. Viscoelastic was injected into the anterior chamber following which nuclear extraction was done with syringe irrigation. Then, cortical material was aspirated. Finally, PC IOL was inserted and the incision closed with sutures. One surgeon for demonstration did four sutureless operations. Subconjunctival injection of gentamycin 20 mg was given to all patients at the end of the operation. Patients were also given two bottles of a combination of Dexamethasone 0.1% and Chloramphenicol 1% eye drops to apply 4 times a day. Ciprofloxacin 500 mg po twice daily for 5 days and Ketrolac, a Non-Steroidal Antiinflamatory Drug (NSAID) 30 mg po twice daily for 7 days was given for every patient. A follow up arrangement was then made on the first postoperative day and after one, four and eight weeks. Outcome of extra-capsular cataract extraction 3 -----------------------------------------------------------On follow up, visual acuity was taken at 6 meters using Snellen's illiterate "E" chart. Slitlamp biomicroscopic and direct ophthal-moscopic examinations were done to all patients who returned on their 4 and 8 th week's of follow up. In those patients suspected of having raised intraocular pressure, schiotz tonometry was used to confirm it. Patients were also asked to participate in an interviewer-administered questionnaire adopted from other similar researches (4,16,17) . It included demographics, patients' subjective satisfaction regarding visual improvement and their daily activity after the operation. The data was entered into a computer in Epi Info version 6.04 and after cleaning; data analysis was done with the same program. Results A total of 214 patients had ECCE with PC IOL insertion done in the 5-day campaign. Out of the 214-study population, 174 (81.3%) were followed up to the 8th week and also completed the entire interview and examination. Seventy-six (43.7%) of the 174 patients were males and 98 (56.3%) were females. The age and sex distribution of patients is given in table 1. Table 1: Age and sex distribution of the study population, Menelik II hospital 1999. Sex Total Age (years) Male Female