Abstract
Suboptimal cataract surgery outcomes remain a challenge in most developing countries. In Ghana, about 2 million people have been reported to be blind due to cataract with about 20% new cases being recorded yearly. The aim of this study was to evaluate postoperative correction of refractive errors after cataract surgery in a selected eye hospital in Ashanti Region, Ghana. This was a retrospective study where medical records of patients (aged 40–100) who reported to an eye hospital in Ghana from 2013–2018 were reviewed. Included in the study were patients aged ≥40 years and patients with complete records. Data on patient demographics, type of surgery, intra-ocular lens (PCIOL) power, availability of biometry, postoperative refraction outcomes, pre- and postoperative visual acuity were analyzed. Data of two hundred and thirteen eyes of 190 patients who met the inclusion criteria were analyzed. Descriptive analysis and Chi-square test were carried out to determine the mean, median, standard deviation and relevant associations. The mean ± SD age was 67.21±12.2 years (51.2% were females). Small Incision Cataract Surgery (99.5%) with 100% IOL implants was the main cataract surgery procedure in this study. Pre-operative biometry was performed for 38.9% of all patients on their first eye surgery and 41.5% for second eye surgeries. About 71% eyes in this study were blind (presenting VA<3/60) before surgery; 40.4% had post-operative VA <3/60. Pre-existing ocular comorbidities discovered post- surgery, attributed to suboptimal visual outcomes. More than half (55.3%) of patients did not undergo postoperative refraction due to loss to follow-up. Year of surgery (p = .017), follow up visits< 2months (p < .0001) and discovered comorbidity post-surgery (p = .035) were the factors significantly associated with postoperative refraction. Myopia and compound myopic astigmatism were the dominant refractive error outcomes. The timing of post-operative refraction had a significant effect on postoperative refraction done. These findings indicate a clinically meaningful significance between completion of postoperative care and postoperative refraction done. Consequently, with settings in most developing countries, where less biometry is done, it is appropriate that post-operative refractive services are encouraged and done earlier to enhance the patients’ expectations while increasing cataract surgery patronage.
Highlights
More than 90% of the global burden of blindness from cataract can be found in developing countries [1, 2]
We present a study on the surgical approaches employed and postoperative refractive error correction after cataract surgery in a developing country
The last event was to characterize the outcomes after postoperative refraction; which was confirmed through the presence of the best corrected visual acuity (BCVA) and the refractive error as stated in the patient folders
Summary
More than 90% of the global burden of blindness from cataract can be found in developing countries [1, 2]. Surgical extraction remains the best intervention for blinding cataract, residual refractive errors are common after surgery. Refractive error correction after cataract surgery is often necessary as high magnitudes of residual refractive errors are a major obstacle to successful surgical outcomes. There is a need for more accurate intra-ocular lens (IOL) power estimation in order to minimise the resulting residual refractive errors and maximize surgical benefits. In addition to increasing cataract surgical rates, high quality of cataract surgical outcomes contributes to achieving targets related to the Sustainable Development Goals of universal health care [4]
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