La chirurgie de la cataracte à petite incision manuelle : experience d’un service régional de soins oculaires au Togo

Abstract

In order to fight against blindness in the central region of Togo, a project was implemented in a partnership between the Ministry of Health and an international Non-Governmental Organization: the Swiss Red Cross. Cataract surgery underwent an annual audit of the research-action type, in order to improve the functional results of patients. One of the recommendations of these audits was the introduction of manual small incision surgery in place of the classic extracapsular technique. This study had for its objective to evaluate the functional results and follow-up of patients undergoing the new technique compared with quality standards of cataract surgery according to the World Health Organization. This study was carried out by retrospective analysis of records and operative reports of patients over twenty years of age undergoing manual small incision cataract surgery from June 2012to June 2015. Out of a total of 1292patients undergoing cataract surgery in the five districts covered by the project during the same period, 1003patients met the inclusion criteria (77.63%). Among the 1003cases, 504 (50.25%) were male, while 499 (49.75%) were female. The overall mean age was 62years. The cataract was total in 84.65% of cases and partial in 15.35% of cases where visual acuities were quantifiable. Postoperative complications were dominated by corneal edema (22%). On the first postoperative day, the good results (visual acuity≥3/10), the average results (visual acuity between 3/10and 1/10) and the poor results (visual acuity<1/10) were respectively 41.2%, 50.60% and 8.2% without optical correction, changing to 64.40%, 28.90% and 6.70% after optical correction. Between the first and third week, 855patients (85%) were seen again. The good, average and poor results were respectively 61.90%, 35.70% and 2.40% without correction, going to 85.30%, 12.70% and 2% after optical correction. Among the 85.30% good results, 53% had a visual acuity≥5/10. Residual ametropias are the main cause of poor functional results and the introduction of biometry can contribute to their improvement. Cataract surgery through a well-controlled manual small incision is a promising alternative to the technique of choice, phacoemulsification, which is not yet widely accessible in our low-income countries.