Cataract in the Kingdom of Morocco: indications for surgery and functional results.

AIM: To investigate the results of cataract surgery in different settings in the Kingdom of Morocco. METHOD: At four separate health facilities, 100 consecutive patients undergoing ECCE cataract extraction for age-related cataract were examined pre-operatively and 6-8 weeks post-operative for changes in visual acuity. RESULTS: Thirty-four percent of patients (better eye acuity) and 95.5% of operated eyes had a visual acuity of less than 3/60 pre-operatively. Six to eight weeks post-operatively 84.0% of patients (better eye acuity) and 74.7% of operated eyes achieved a visual acuity of 6/18 or better. Of 198 eyes having an intraocular lens (IOL) implanted, 87.9% achieved 6/18 and 3.0% were less than 6/60 post-operatively. Of 202 eyes having cataract surgery without an IOL, 61.7% achieved 6/18 and 4.5% were less than 3/60. The proportion of eyes receiving an IOL in the 4 centres ranged from 29% to 74%. CONCLUSION: Monitoring the pre and post-operative acuity of cataract patients can give useful information on the indications for surgery in different settings, the use of IOLs and the visual outcome. Implantation of an IOL should be encouraged in all people having cataract surgery unless contra-indicated.

[The quality of trichiasis surgery in the kingdom of Morocco]. / Qualité de la chirurgie du trichiasis au royaume du Maroc.

In December 1998, a survey was carried out on the quality of trichiasis surgery, based on a random sample of 750 people chosen from the surgical records of 13 health centres of the provinces of Zagora and Errachidia (Kingdom of Morocco). Among those, 740 people were examined (participation ratio: 98.6%). The study population was mainly composed of women (63.8%) and people > 40 years (83.5%). The average age was 51.8 (48.5 for women and 57.4 for men). The most common surgical technique was the bilamellar tarsal rotation procedure. In 98.7% of cases, the operation concerned one of the upper eyelids, and in 58.5% of cases the right eye. At the time of the interviewers' visit, 11.1% of the people examined were blind (vision < 1/20 for the best eye) and 28.9% were visually impaired (vision > 1/20 but < 3/10). In addition, 17.6% of the eyes whose eyelids had been operated on rated as blind and 29% of them as visually impaired. The definition of recurrence was the presence of at least one or more eyelashes in contact with the eyeball. The recurrence rate is estimated to be 15.8%, divided into 2 categories: (1) Severe or total recurrence (2.4%) - At least one eyelash from the median part of the lid margin is in contact with the cornea - and, (2) Partial recurrence "One or more eyelashes affect the corners of the eyelids but never rub against the cornea" (13.4%). 14. 3% of the patients operated on were removing their eyelashes regularly which is a clear indicator of the failure of the operation. The following constitute risk factors for recurrence: being aged over 40, having been operated on in Errachidia province, having been operated on by a general practitioner or by an ophthalmologist. However, "time elapsed since the operation" does not appear to influence the recurrence rate in each of the three cohorts which were subsequently formed using the date of the operation (retrospectively). Most recurrences seem to develop during the first twelve months after the operation. The post-operational complications/sequelae detected were rarely sight-threatening, except in four cases, i.e., three ptoses and one case of tegumental necrosis with permanent exposure of the cornea. The most common complications were excessive rotation of the lid margin (over-correction) (2.3%) and cutaneous necroses with no exposure of the cornea (3.6%). In this series, 15.7% of the eyes examined presented central corneal opacity and 2.1% xerosis. In 1.6% of cases the eyeball was either destroyed (phthisis bulbi) or absent. A majority of patients (51.8%) was affected by persistent lacrimation or secretions.

[Cataract-related blindness in Morocco. The Moroccan Group of Epidemiologic Evaluation of Blindness]. / La cataracte cécitante au Maroc. l'Equipe Marocaine d'Evaluation Epidémiologique de la Cécité.

The lack of sound and recent epidemiological data on the prevalence and causes of blindness has hampered the development and evaluation of the Moroccan Programme for the Prevention of Blindness. For this reason a population-based survey using a stratified (urban/rural) sampling design for random selection of clusters was carried out in the Kingdom of Morocco from May 15 until June 30, 1992. The procedures used for this survey were those proposed by the WHO Programme for the Prevention of Blindness. A total of 10,198 people were recruited and 8878 examined for a participation rate of 87%. The size and representativity of the sample satisfactorily guaranteed the order of magnitude and accuracy of eye health indicators used by health planners. The crude point prevalence of blindness was 0.8%, that of bilateral poor vision was 2.3%, and that of unilateral poor vision was estimated to be 2.8%. Based on these findings 195,000 people would be blind and 1,300,000 would be at risk of becoming so, for a total of approximately 1,500,000 people with serious visual impairment. Age-related cataract was the most important cause of blindness (45.5%) and bilateral poor vision (43.1%). The prevalence of cataract-related visual impairment--operable or inoperable--was estimated to be 2.1% of the survey sample. Applying a realistic algorithm to the survey data, it was estimated that the backlog for cataract surgery in Morocco in 1992 was in the order of 502,000 eyes in approximately 287,000 people. The percentage of patients who had undergone cataract surgery in hospital was 0.8%. Posterior lens dislocation according to the traditional "couching" method was noted in 0.1% of people studied. It was estimated that 25% of the demand for cataract surgery was covered by available facilities and that 40% of people with aphakia could not obtain eye care.