Nucleus management with Fishhook.

The fishhook technique developed at the Lahan eye hospital is widely used in Nepal and other countries. Its specialty is the extraction of the nucleus with a bent 30-G needle (Fishhook) out of the capsular bag and the self-sealing tunnel. All sizes of nuclei can be extracted. The fishhook technique has a short learning curve, a low complication rate and provides excellent immediate visual outcome. It is cost-effective and has proved to be useful also for high-volume cataract surgery and thus can play an important role in the reduction of cataract blindness.

Loupe magnification for small incision cataract surgery--an alternative to microscope magnification?

A Prospective randomized controlled study was conducted to compare outcome of Small Incision Cataract Surgery (SICS) using microscope or loupe magnification. Two hundred fifty one patient with mature cataract were randomly allocated to SICS-Fishhook Technique with either microscope (127 eyes) or loupe (124 eyes) magnification. Intra- and postoperative complications and immediate visual outcome were analyzed. Nearly two third (microscope 65% and magnifying loupe 62.9%) of all patients had good visual outcome on first postoperative day. Poor outcome (<6/60) was recorded in 8% (microscope group) and 7% (magnifying loupe group). Mean visual acuity with Snellen was 0.39 (SD 0.2) in microscope group and 0.38 (SD 0.2) in magnifying loupe group. Intra operative complications were comparable in both groups. Mean surgery time with loupe magnification was significantly shorter. Comparatively equivalent good surgical outcome was achieved with loupe as well as with microscope magnification. However performing SICS with loupe magnification is significantly faster. Small incision cataract surgery with loupe magnification is safe and effective procedure for cataract surgery so it can play a role in reducing cataract blindness in developing countries of the world.

A prospective study of 413 cases of lens-induced glaucoma in Nepal.

PURPOSE: To determine the frequency and types of lens-induced glaucoma (LIG), reasons for late presentation and outcome of current management. METHODS: Prospective case series of 413 patients/eyes with LIG over a 12-month period in 1998; 311 of these patients underwent cataract surgery. Visual acuity and intraocular pressure (IOP) were pre- and postoperatively assessed. RESULTS: Four hundred and thirteen (1.5%) of 27,073 senile cataracts seen in the outpatient department of Sagarmatha Choudhary Eye Hospital, Lahan, Nepal presented with LIG. There were 298 (72%) phacomorphic cases and 115 (28%) phacolytic glaucoma. Pain for more than 10 days was reported by 293 (71%) patients. The majority, 258 (62.4%), travelled a distance of more than 100 kms to the hospital. The major reasons for late presentation were "no escort" in 143 (34.6%) and "lack of money" in 128 (31.0%) cases. At presentation the IOP was more than 30 mm Hg in 327 (79%) eyes. Following cataract surgery, 251 (80.7%) had 21 mm Hg or less at discharge. The visual acuity was hand-movement or less before surgery in all eyes; at discharge 120 of 311 operated eyes (38.6%) achieved 6/60 or better, 97 (31.2%) less than 6/60, and 94 (30.2%) less than 3/60. The main causes for poor outcome in 94 cases were optic atrophy in 32 (34%) eyes, uveitis in 25 (26.6%)eyes and corneal oedema in 24 (25.5%) eyes. CONCLUSION: The results highlight the importance of early diagnosis and treatment of visually disabling cataract. There is a need to educate both the patient and the cataract surgeon of the dangers of lens-induced glaucoma and of the poor outcome if treatment is delayed.

Postoperative astigmatism after intracapsular cataract surgery: results of a randomised controlled trial in Nepal.

PURPOSE: Postoperative astigmatism following intracapsular cataract extraction with or without anterior chamber intraocular lens implantation is reported as an outcome from a randomised controlled trial. METHODS: Five hundred and two of 1002 eyes randomised to intracapsular cataract extraction with anterior chamber intraocular lens (ICCE/AC IOL) and 417 of 998 eyes to intracapsular cataract extraction with aphakic spectacles (ICCE/AS) were seen for objective refraction one year after surgery. The prevalence and axis of astigmatism were evaluated using univariate analysis. Logistic regression was used to compare the postoperative astigmatism between the groups. RESULTS: Acceptable astigmatism (-0.5 to 0.0 DCyl) in the AC IOL group was found in 60 (12.0%) patients (95% CI 9.1%-14.9%) and in the aphakic spectacles group (AS) in 69 (16.5%) patients (95% CI 12.9%-20.1%), moderate astigmatism (-1.0 to-1.5 DCyl) was found in 153 (30.4%) patients (95% CI 26.4-34.6%) in ACIOL group and in 288 (69.1%) patients (95% CI 64.6%-73.6%) in AS group; and large astigmatism (-2.0 to - 8.0 D Cyl) was found in 289 (57.6%) patients (95% CI 53.1%-61.6%) in ACIOL group and in 60 (14.4%) patients (95% CI 11.0% 17.8%) in AS group. Large astigmatism was approximately four times more common in the ICCE/AC IOL group compared to ICCE/AS group. In both groups, most patients had "against-the-rule" astigmatism, 446 (88.8%) (95%CI 86.0%-91.6%) in AC IOL group and 348 (83.5%) (95%CI 79.9%-87.1%) in AS group. CONCLUSION: Astigmatism is common after intracapsular cataract extraction. Insertion of an anterior chamber IOL increases the risk of astigmatism.