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.

Overview on community ophthalmology.

Community ophthalmology requires a comprehensive approach for primary, secondary and tertiary prevention of all eye diseases like vitamin A deficiency, trachoma, measles, diabetic retinopathy, refractive errors, etc. Community ophthalmology is based on the principles of primary health care approach. Equitable distribution, community involvement, focus on prevention, appropriate technology and multisectorial approach are to name a few in primary health care approach. In India, National Programme for Trachoma Control was launched in 1963 and National Programme for Control of Blindness was launched in 1976. Prevention of blindness was included in 20-point plan in early 1980s. Increase in blindness was reassessed in 1986-89 and the strategy was changed. World Bank came to help in planning 11 million cataract operations in 7 years in 7 States where there was the highest prevalence of cataract. Departments of community ophthalmology have recently been developed in several institutions. If the problem of blindness is to be solved, extension of community-based approach including all strata of society is the need of the hour.

The epidemiology of trachoma in southern Malawi

A population-based prevalence survey of ocular disease was conducted in the Lower Shire Valley of Malawi in 1983. A total of 5;436 children less than 6 years of age and 1;664 persons greater than or equal to 6 years were examined. The prevalence of inflammatory trachoma peaked in the 1-2-year-old age group at 48.7 percent and declined rapidly with age to less than 5 percent by age 15. The prevalence of cicatricial trachoma was low in young children and climbed gradually with age to greater than 40 percent among those greater than or equal to 50 years. Risk factors for infLammatory disease in young children included low socioeconomic status of the family; long walking distance to the household's primary source of water; absence of a latrine in the family compound; and presence of trachoma among siblings. Indices of crowding practices were not associated with inflammatory disease. An apparent inverse association of facewashing and inflammatory trachoma in children did not hold up when adjusted for other risk factors