Sutureless cataract surgery with nucleus extraction: outcome of a prospective study in Nepal

Abstract

Aim: To report the short and medium term outcome of a prospective series of sutureless manual extracapsular cataract extractions (ECCE) at a high volume surgical centre in Nepal. Methods: Cataract surgery was carried out, on eyes with no co-existing diseases, in 500 consecutive patients who were likely to return for follow up. The technique involved sclerocorneal tunnel, capsulotomy, hydrodissection, nucleus extraction with a bent needle tip hook, and posterior chamber intraocular lens (PC-IOL) implantation according to biometry findings. Surgical complications, visual acuity at discharge, 6 weeks, and 1 year follow up, and surgically induced astigmatism are reported. Results: The uncorrected visual acuity at discharge was 6/18 or better in 76.8% of eyes, and declined to 70.5% at 6 weeks' follow up, and 64.9% at 1 year. The best corrected visual acuity was 6/18 or better in 96.2% of eyes at 6 weeks and in 95.9% at 1 year. Poor visual outcome (<6/60) occurred in less than 2%. Intraoperative complications included 47 (9.4%) eyes with hyphaema, and one eye (0.2%) with posterior capsule rupture and vitreous in the anterior chamber. Surgery led to an increase in against the rule astigmatism, which was the major cause of uncorrected visual acuity less than 6/18. Six weeks postoperatively, 85.5% of eyes had against the rule astigmatism, with a mean induced cylinder of 1.41 D (SD 0.8). There was a further small increase in against the rule astigmatism of 0.66 D (SD 0.41) between 6 weeks and 1 year. The mean duration of surgery was 4 minutes and the average cost of consumables, including the IOL, was less than $10. Conclusion: Rapid recovery of good vision can be achieved with sutureless manual ECCE at low cost in areas where there is a need for high volume cataract surgery. Further work is required to reduce significant postoperative astigmatism, which was the major cause of uncorrected acuity less than 6/18.

Study of Intraoperative Complications in Small Incision Cataract Surgery, its Management and Visual Outcome

“…Hennig and co-authors 16 reported posterior capsular rent in 0.2% cases whereas Khan reported 3.33% 17 .…”

“…Similarly, Hennig et al 16 in their study reported a BCVA of 6/18 or better in 96.2% and 88.3% respectively.…”

High-volume surgery in developing countries

“…The cost of these can be reduced to less than d5 through local manufacture and bulk purchase. 11 In most communities, patients are willing to pay the equivalent of 1 month's wages for a cataract operation. 12 This should be the average price for cataract surgery.…”

“…Using this system, the median surgical time (time required by the ophthalmologist) per case can be reduced to less than 5 min. 11 In order to maximise surgical output, the time between surgeries must be reduced, as well as operating time. If…”

“…It is estimated that the mean cost of consumables (including a rigid PMMA IOL) is between $5 and $7. 11,27 With efficient use of operating theatre personnel, the mean surgical time is between 5 and 12 min. 11,27 Using this technique 70% of patients had an uncorrected vision of 6/18 or better at 6 weeks after surgery.…”