Results and safety profile of trainee cataract surgeons in a community setting in East Africa

Abstract

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.

Factors associated with visual outcomes after cataract surgery: A cross-sectional or retrospective study in Liberia

“…This was slightly higher than other studies from India and Nepal [15][16][17][18] but less than most studies from Africa. [23][24][25] Mavrakanas et al reported an overall complication rate of 8.2% with less in MSICS surgeries (5.3%) as compared to ECCE (10.2%). [23] However, these surgeries were carried out by cataract surgeons undergoing training.…”

“…[23][24][25] Mavrakanas et al reported an overall complication rate of 8.2% with less in MSICS surgeries (5.3%) as compared to ECCE (10.2%). [23] However, these surgeries were carried out by cataract surgeons undergoing training. [23] Complication rate was also much lower than what was reported on PRECOG and other studies.…”

“…However, outcomes of this study was better than many other studies from Africa, including PRECOG study. [22][23][24][25] This could be due to availability of well-trained surgeons,…”

“…[23] However, these surgeries were carried out by cataract surgeons undergoing training. [23] Complication rate was also much lower than what was reported on PRECOG and other studies. [25] However, complications were higher compared to Matta et al (1.4%) and Sherwin et al (2.5%).…”