Appropriate technology for cataract surgery

Outcomes of extracapsular surgery in eye camps of eastern Nepal

BACKGROUND

Extracapsular cataract (ECCE) surgery is becoming increasingly popular in surgical eye camps of developing countries. This study assesses the outcome of 166 eyes at 6 weeks and 14 and 32 months after ECCE with and without implantation of intraocular lens in refugee camps of eastern Nepal.

METHOD

All patients operated on in seven refugee camps during the 3 years before the assessment were included in the study population. Visual acuity, examination of anterior segment and posterior segments, and grading of capsular opacification using a standardised grading system were performed.

RESULTS

Of 166 eyes examined, of which 49.4% were aphakic, 58% of eyes had very poor functional vision (WHO severe visual impairment-VA <6/60). After refraction and best correction 19% still had very poor vision. The aphakic eyes had both significantly poorer functional and best corrected vision than the pseudophakic eyes. In patients with intact posterior capsule clinically significant posterior capsular opacification was observed in over 10% of eyes at 14 months and 30% at 32 months.

CONCLUSION

It was found that ECCE surgery in eye camps in this setting gave unacceptable outcomes because of a high rate of capsular rupture and posterior capsular opacification. Careful consideration should be given to the quality of the surgical set up and available resources and possibilities of postoperative follow up when ECCE is introduced in eye camps.

Can cataract be prevented?

The feasibility of preventing cataract by elimination of risk factors or by anti-cataract therapy is reviewed. Elimination of the major risk factors in Western countries would be difficult, although it has potential in the developing world. Various approaches to drug therapy have been made but ran into problems. The development of aldose reductase inhibitors received by far the greatest financial support but problems with toxicity were rapidly followed by the collapse of the original hypothesis. The case of aspirin, paracetamol and ibuprofen built up more slowly with no encouragement from the pharmaceutical industry. Positive results have been achieved in vitro, and in the prevention of diabetic cataract in rats, as well as the identification of an association with a protective effect against cataract in human patients. A clinical trial of these compounds is required. Other anti-cataract agents are also being investigated.