ABSTRACT
The purpose of this study was to investigate the incidence and risk factors associated with retinal redetachment after silicone oil (SO) removal in the African population. A retrospective cohort study was performed on patients undergoing SO removal over a period of 4 years. The risk factors assessed were (1) characteristics of the retinal detachments including type of retinal detachment, type, number and location of the retinal tears, and proliferative vitreoretinopathy (PVR) score, and (2) surgical factors including type of silicone oil used, use of laser prior to SO removal, and location of the laser (360° or around the tear only). SO was removed either through a pars plana approach or transpupillary approach and anterior limbal incision. Ninety-nine eyes met the inclusion criteria during the study period. Twelve patients (12 %) had retinal redetachment after SO removal. Factors associated with redetachment were a preexisting macular hole, PVR grade B or worse, and no intraoperative endolaser photocoagulation. The incidence of redetachment in African population is similar to that reported from developed countries and other advanced vitreoretinal centers. Redetachment occurred at higher rates in patients with preexisting macular holes and tears who did not receive intraoperative endolaser photocoagulation and patients with a severe grade of PVR.
Subject(s)
Endotamponade/adverse effects , Postoperative Complications/epidemiology , Retinal Detachment/surgery , Risk Assessment/methods , Silicone Oils/adverse effects , Vitrectomy/adverse effects , Adolescent , Adult , Aged , Child , Female , Follow-Up Studies , Humans , Incidence , Male , Middle Aged , Postoperative Complications/diagnosis , Postoperative Complications/etiology , Recurrence , Retinal Detachment/diagnosis , Retrospective Studies , Risk Factors , Tanzania/epidemiology , Visual Acuity , Young AdultABSTRACT
PURPOSE: To evaluate the results and safety profile of assistant medical officer ophthalmologists (AMO-O) performing cataract surgery in the last stage of their surgical training, before their appointment to local communities. METHODS: We retrospectively analyzed the records of patients who underwent cataract surgery by AMO-Os at Dar es Salaam, Comprehensive Community Based Rehabilitation for Tanzania Disability Hospital between September 2008 and June 2011. Surgical options were either extracapsular cataract extraction (ECCE) or manual small incision cataract surgery (MSICS), both with polymethylmethacrylate intraocular lens implantation. RESULTS: Four hundred and fourteen patients were included in the study. Two hundred and twenty-five (54%) underwent ECCE and 189 had MSICS. Mean logarithm of the minimum angle of resolution (logMAR) uncorrected visual acuity (UCVA) improved from 2.4 ± 0.6 preoperatively to 1.3 ± 0.8 1 week postoperatively (t-test, P < 0.001) and to 1.1 ± 0.7 3 months postoperatively (t-test, P < 0.001). Mean logMAR best-corrected visual acuity (BCVA) was 0.7 ± 0.5 1 week postoperatively and 0.6 ± 0.5 3 months postoperatively. There was no significant difference in mean logMAR UCVA (P = 0.7) and BCVA (P = 0.7) postoperatively between ECCE and MSICS. 89.5% achieved BCVA better than 6/60 and 57.3% better than 6/18 with a follow-up of 3 months. Posterior capsule rupture and/or vitreous loss occurred in 34/414 patients (8.2%) and was more frequent (P = 0.047) in patients undergoing ECCE (10.2%) compared with MSICS (5.3%). CONCLUSION: AMO-O cataract surgeons at the end of their training offer significant improvement in the visual acuity of their patients. Continuous monitoring of outcomes will guide further improvements in surgical skills and minimize complications.
