Incidence of vitreous loss and visual outcome following cataract surgery by surgeons with various levels of experience at a tertiary eye care center in North India

Purpose: To determine the incidence of vitreous loss and visual outcome after a vitreous loss during cataract surgery performed by surgeons with various levels of experience in adults >40 years of age at a tertiary eye care center in North India. Methods: The study was conducted at a tertiary eye care center in North India. This was an observational, retrospective, cross-sectional study of patients who underwent cataract surgery from August 1, 2011 to July 31, 2014. All adult cataract cases who were operated on from August 1, 2011 to July 31, 2014 and who experienced vitreous loss during their surgery were included in the study. The visual outcomes of these patients who experienced vitreous loss during cataract surgery in uncomplicated cataract and were managed using standard automated vitrectomy techniques were assessed for different cataract surgical techniques (extracapsular, small-incision, and phacoemulsification) as well as at different levels of skill of the operative surgeon (consultant, short term fellow, and long-term fellow). Details of the postoperative period and best-corrected visual acuity (BCVA) were collected from patient records by the principal investigator on day 1, 1 week, 4 weeks, 6 weeks, and 3 months post cataract surgery. Results: Vitreous loss occurred in 374 out of 18,430 patients who underwent cataract surgery from August 1, 2011 to July 31, 2014. The overall incidence of vitreous loss in our study was found to be 2.03% with consultants having a rate of 1.66%, short-term fellows at 5.19%, and long-term fellows at 2.02%. Two hundred eighty-eight patients of the 374 cases followed up for 3 months at the hospital and 75.69% of these patients had a final visual acuity of ?6/18. Conclusion: In an institute with a structured training program for residents/trainees, the vitreous loss rate is low during cataract surgery. Early intervention and proper management with the standard microsurgical technique by experienced hands can improve the final visual outcome in eyes with vitreous loss. Cystoid macular edema and corneal edema were the most common causes of poor postoperative vision

A Study of Profile of Patients with Cataract.

Background: Cataract blindness is a public health problem of major proportions in developing countries. Intra capsular cataract extraction with aphakic spectacles has been the standard surgical technique for restoring sight. Cataracts, the world's leading cause of blindness, are an enormous public health problem in both developing and industrialized countries. Objective: To study clinical profile of patients with cataract. Methods: After applying inclusion and exclusion criteria as well as after ethical consideration only patients having cataract were included in the study. In this way, it was possible to include the 1000 patients over a period of two years. Present study was hospital based cross sectional study. A pre tested, semi structured questionnaire was used to collect the data. Complete detailed history was taken as per the questionnaire. Thorough clinical examination was carried out. The collected data was entered in Microsoft Excel Sheet and analyzed with the help of proportions. Results: The prevalence of cataract was highest in the age group of 51-60 years i.e. 45.1%. The most common prevalent type of cataract was found to be mature cataract in 50.5% of cases followed by hyper-mature cataract in 34.7% of cases. The overall incidence of capsular rupture was 4.7%. Highest incidence of capsular rupture was seen in complicated cataract followed by intumescent cataract. Incidence of vitreous loss was most commonly present in intumescent cataract followed by complicated cataract. 51% of patients recovered to normal vision of 6/6. 41.2% of patients had corrected vision from 6/60 to 6/18. Conclusion: The prevalence of cataract is common above 50 years of age. The patients reporting to the hospital for the complaint of loss vision commonly have mature or hyper-mature cataract. Complications are less in the mature and hyper-mature type of cataract.

Cataract Surgery in Asian Countries – An Overview.

Cataract, the leading cause of blindness in the world, is treated with surgery, and is the most common eye surgery performed. A PubMed search was done to review the spectrum of practice of cataract surgeries in Asian countries. Coverage for surgeries varied in different countries which depends mainly on the surgical facilities available in the region or country. Outreach programs, free surgeries and reimbursement of transport influence this. The cost of cataract surgery depends on type of cataract operation, government/private hospital, and facilities provided in the hospital, day care/in patient surgery, and economic status of people in the region/country. Phaco surgery was more expensive than extracapsular cataract extraction (ECCE) and manual small incision cataract surgery (SICS). Intracapsular cataract extraction (ICCE) was cheaper than ECCE in India. Local anaesthesia (retrobulbar, peribulbar, subtenon and topical) is used compared to general anaesthesia. Pain was more in topical compared to regional anaesthesia though no pain was reported for phacoemulsification under topical. Several manouveres have been utilised in difficult cases to optimise the outcomes. These include invention and modification of instruments, phacodynamic settings and surgical techniques. Specific regimes for pupillary dilatation have been recommended. In Diabetics, trenching was difficult. Elimination of cotton balls reduced fibres in the anterior chamber. Innovations in intraocular lenses (IOL) are glued IOL, Artisan iris fixated IOL, intrascleral fixation of IOL with Y sutures. Visual outcomes varied based on techniques of surgeries and types of IOLs used. The advancement of techniques and instrumentation has benefited patients with cataracts by improving outcomes.

Visual outcomes and incidence of vitreous loss among third-year ophthalmology residents performing manual small incision cataract surgery / 国际眼科杂志(Guoji Yanke Zazhi)

AIM:To determine the visual outcome and the incidence of vitreous loss in patients undergoing manual small incision cataract surgery(MSICS)by third-year ophthalmology residents.METHODS:Hospital records of 799 consecutive patients undergoing MSICS at Department of Ophthalmology,Prapokklao Hospital by third-year ophthalmology residents between July 2005 and June 2007 were reviewed.Bestcorrected visual acuity(BCVA)were compared between the eyes operated by residents and those operated by the staffs.For the complication of vitreous loss,the study group(patients with vitreous loss)were compared with the control group(patients without vitreous loss)using analytic case-control study.RESULTS:One month postoperatively,91.0%of patients in resident group and 92.5%in the staff group had visual acuity of 6/18 or better.The difference in visual outcome between the two groups was not statistically significant(P =0.526).The incidence of vitreous loss among residents was 5.01%(20/399)and 1.00%(4/400)among the staff.The overall incidence of vitreous loss was 3.0%.The odds that the eyes in the resident group would have an intraoperative complication of vitreous loss were 5.22 times,the odds that the eyes in the staff group would have such a complication(P = 0.002,95%confidential interval(Cl)of relative risk =1.769-15.426).CONCLUSION:Good visual acuity can be achieved after resident perfoming MSICS.The vitreous loss rate in this study is high.

Causes of Unsuccessful Visual Outcome after Cataract Surgery

We evaluated preoperative characteristics, intraoperative problems, and postoperative complications among the patients who underwent phacoemulsification and posterior chamber intraocular lens implantation by one surgeon. Eyes with postoperative visual acuity was lower than preoperatively or less than 0.4 on Han`s visual acuity chart were designated Group A, 68 eyes (16.4%), and the remaining eyes were Group B, 46 eyes (83.6%). Preoperative characteristics in Group A were uveitis (16.2%), diabetic retinopathy (13.2%), glaucoma (11.8%), macular abnormality (11.8%), etc. Intraoperative complications, posterior capsule reptures with vitreous loss occurred in 21 eyes (5.1%). 8 eyes (11.8%) of the 21 eyes were Group A, 13 eyes (3.8%) were Group B, and the difference between both groups were statistically significant (p<0.01). Postoperatively, cystoid macular edema was occurred in 12 eyes (2.9%). 11 eyes (16.2%) of 12 eyes were Group A, 1 eye (0.3%) was Group B, and the difference between both groups were statistically significant (p<0.01) and 4 eyes were preceded by posterior capsule rupture. From the above results, we recognized the importance of avoiding posterior capsule rupture with vitreous loss. If it does occur, we recommend that meticulous anterior vitrectomy be performed. Following these guidlines should reduce the rate of unsuccessful cataract sugery.