Impact of cataract surgery in reducing visual impairment: a review

Factors associated with delayed uptake of cataract surgery among adult patients at Mulago National Referral Hospital, Uganda

BACKGROUND

Cataract is the leading cause of blindness globally. Many patients with cataract in developing countries delay to come for cataract surgery.

OBJECTIVES

This study aimed to determine the factors associated with delayed uptake of cataract surgery among adult patients seen at Mulago National Referral Hospital eye clinic in Uganda.

METHODS

Employing a hospital based cross-sectional study, adult patients with cataract and having moderate visual impairment or blindness were recruited. Patient-related factors for delayed surgery were assessed using a predetermined questionnaire. Data was analyzed using stata version 14.2. Logistic regressions were used to determine the factors associated with delayed uptake of cataract surgery among these patients.

RESULTS

Eighty two participants with operable cataract were evaluated. Females were 44 (54%) and the mean age of participants was 67 years. Fifty three (65%) had delayed uptake of cataract surgery. The factors associated with delayed uptake of cataract surgery among patients with cataract were financial constraint, felt no need for surgery and good unilateral vision.

CONCLUSIONS

Financial constraints, no felt need for cataract surgery and having good unilateral vision are the factors associated with delayed uptake of cataract surgery among cataract patients. We recommend cataract surgical outreach to remote areas and health education.

Prevalence, care-seeking practices and impact of self-reported vision impairment in Southwest Cameroon: a community-based study

OBJECTIVES

To establish the prevalence of self-reported vision impairment (VI) in Southwest Cameroon and describe associated care-seeking practices, functional limitations and economic hardships.

DESIGN

A three-stage clustered sampling household community-based survey.

SETTING

The Southwest region of Cameroon.

PARTICIPANTS

8046 individuals of all ages residing in the Southwest region of Cameroon.

PRIMARY AND SECONDARY OUTCOME MEASURES

Prevalence of self-reported VI, onset of vision loss, care-seeking practices, diagnosis and treatment, functional limitations, economic hardships on household, beliefs about surgical treatability of blindness and barriers to surgical care.

RESULTS

The estimated prevalence of self-reported VI in Southwest Cameroon was 0.87% (95% CI 0.62 to 1.21). Among participants aged ≥40 years, the prevalence increased to 2.61% (95% CI 1.74 to 3.90). Less than a quarter of affected participants reported difficulty working (20.5%) or trouble going to school (12.0%) as a result of their VI. Yet, over half (52%, n=43) of affected households experienced significant economic hardships due to the VI. Residing in an urban setting (aOR 1.16, 95% CI 1.04 to 1.30) and belonging to a higher socioeconomic status (aOR 1.13, 95% CI 1.02 to 1.26) were factors associated with the belief that certain types of blindness were surgically reversible. Formal care was not sought by 16.3% (n=8) of affected participants. Cataracts was the leading diagnosis among participants who did seek formal care (43.2%, n=16), although 93.8% of these cases were not surgically treated, primarily due to a lack of perceived need.

CONCLUSION

The prevalence of individuals who report vision impairment in Southwest Cameroon is considerably lower than prior published estimates based on visual physical examinations. Routine community-level screening and cost financing schemes could improve detection of pre-clinical eye disease and the utilisation of surgical care. It could also pre-empt disability and economic hardships associated with advanced VI in the region.

Implantable Medical Devices and Tissue Engineering: An Overview of Manufacturing Processes and the Use of Polymeric Matrices for Manufacturing and Coating their Surfaces

Medical devices are important diagnosis and therapy tools for several diseases which include a wide range of products. Technological advances in this area have been proposed to reduce adverse complication incidences. New technologies and manufacturing processes, as well as the development of new materials or medical devices with modified surface and the use of biodegradable polymeric devices such as a substrate for cell culture in the field of tissue engineering, have attracted considerable attention in recent years by the scientific community intended to produce medical devices with superior properties and morphology. This review article focused on implantable devices, addresses the major advances in the biomedical field related to the devices manufacture processes such as 3D printing and hot melting extrusion, and the use of polymer matrices composed of copolymers, blends, nanocomposites or grafted with antiproliferative drugs for manufacturing and/or coating the devices surface.

Impact of Cataract Surgery on Functional Balance Skills of Adults

Objectives:

To investigate the impact of phacoemulsification surgery and intraocular lens implantation on the functional balance skills of adults.

Materials and Methods:

This prospective study included patients with cataract who were recommended phacoemulsification surgery and intraocular lens implantation between May and October 2016. The Berg Balance Scale and Tinetti Gait and Balance Test were performed by a physical therapy specialist before and 1 month after surgery. Patients were analyzed in terms of age, visual acuity, and balance. Balance scores before and after cataract surgery were compared. We also compared patients with high (≤2 LogMAR) and low (>2 LogMAR) visual acuity. P values below 0.05 were accepted as statistically significant.

Results:

Fifty-one patients (27 female and 24 male, mean age 66.96 years) were included in the study. One month after surgery, the patients’ Berg Balance scores and Tinetti Gait and Balance scores were increased by 3.60±5.00% and 4.14±6.55%, respectively. Postoperative increase in visual acuity was significantly greater in the 16 patients with visual acuity less than 0.05 (>2 LogMAR) (p=0.036), but balance scores were not significantly different.

Conclusion:

Visual acuity is significantly improved one month after cataract surgery, which also leads to significant increases in low functional balance scores among patients with poorer vision. The rapid increase in vision after cataract surgery enhances balance skills, resulting in safer mobility and increased quality of life.

Ten years of intraoperative floppy iris syndrome in the era of α-blockers

Introduction

The use of alpha-1 receptor antagonists in the treatment of benign prostatic hyperplasia (BPH) has created a problem in ophthalmic surgery, the so-called intraoperative floppy iris syndrome (IFIS). This consists of a billowing iris, insufficient pupillary dilation with progressive intraoperative miosis, and protrusion of iris tissue through the tunnel and side port incision that are made for access to the anterior chamber during surgery. IFIS presents particular difficulties in cataract surgery which is carried out through the pupil with manipulations in the immediate vicinity of the iris. The complications range from poor visibility of the operative field to iris damage with the surgical instruments and to rupture of the posterior capsule, with loss of lens material into the vitreous body.

Material and methods

A comprehensive literature review was performed using MEDLINE with MeSH terms and keywords 'benign prostatic hyperplasia', 'intraoperative floppy iris syndrome', 'adrenergic alpha-antagonist' and 'cataract surgery'. In addition, reference lists from identified publications were reviewed to identify reports and studies of interest from 2001 to 2017.

Results

The A total of 95% of experienced ophthalmologic surgeons reported that systematic treatment with tamsulosin represents a challenging surgical condition increasing the risk of complications. Alpha-blockers are commonly prescribed, with 1,079,505 packages of tamsulosin prescribed each month in 2014 in Austria. Dose modification may be one way to reduce the risk of IFIS. A lower incidence of IFIS was reported in patients on tamsulosin in Japan, but the recommended dosage was lower than that used in Europe and the US (0.2 mg vs. 0.4 mg).

Conclusions

We showed that not all patients taking tamsulosin experience IFIS. Moreover, larger investigations with a prospective design are needed, including studies to monitor the pre- and post-therapeutic ophthalmologic changes under tamsulosin, as well as urodynamic improvements resulting from this therapy.