Visual outcome following posterior capsule rupture during manual small incision cataract surgery.

Kk Oladigbolu,C Bunce,La Raji,Mm Umar,Jc Buchan,Er Abah

doi:10.4103/njcp.njcp_272_20

Abstract

The quality of cataract surgery can be measured by visual outcome, which is sometimes limited by intraoperative complications, most commonly posterior capsular rupture. The aim of the study was to assess visual outcome at the last visit (≥8 weeks) following posterior capsule rupture (PCR) in patients who had manual small incision cataract surgery (MSICS) managed without access to an automated vitrector. A review of medical records of all manual small incision cataract surgeries performed between January 2013 and December 2016 at the National Eye Centre, Kaduna, Nigeria was conducted. Descriptive statistics and logistic regression analysis were performed using STATA 14.0 to examine risk factors for the development of a poor visual outcome and to assess the impact of PCR on development of poor visual outcome. In total, 405 patients were operated on with MSICS (50.6% males). Mean age was 62.4 (SD 12.6) years. PCR was the most common complication (n = 19 (4.7%)). The proportion of good outcomes (≥6/18) rose from 12.4% non-PCR and 0.0% for those with PCR at day 1 postoperative review, to 71.5 and 26.3%, respectively, by final follow up (P = 0.001). Patients with PCR were 7.0 (P = 0.0001) times more likely to have borderline/poor visual outcome (<6/18) compared to those without PCR. Age >60 years increased the odds of borderline/poor by 1.4 times (P = 0.002). PCR significantly affects the visual outcome of cataract patients in settings with no facilities for automated vitrectomy. Minimizing complications will improve visual outcome of cataract patients and increase uptake of cataract surgical services.

Highlights

Despite the efforts and notable successes of the Vision 2020: The right to sight campaign, cataract remains the leading cause of blindness on earth contributing over one‐third of the global total of 36 million blind.[1]
Much evidence exists to support the claim that, while posterior capsule rupture (PCR) is associated with worse visual outcomes than uncomplicated surgery, good outcomes of cataract extraction by phacoemulsification can be achieved despite PCR.[15,16]
This study demonstrates the detrimental effect of PCR during manual small incision cataract surgery (MSICS) managed without automated vitrectomy on visual outcome compared to those whose surgery was not complicated by PCR

Summary

Introduction

Despite the efforts and notable successes of the Vision 2020: The right to sight campaign, cataract remains the leading cause of blindness on earth contributing over one‐third of the global total of 36 million blind.[1]. The drive to promote accessibility of cataract surgical services in India has seen the CSR rise to over 10,000 operations per million population per year.[3] early in this drive to increase CSR, there were often reports of substantial problems with quality of surgery being delivered. The quality of cataract surgery can be measured by visual outcome, which is sometimes limited by intraoperative complications, most commonly posterior capsular rupture. Aims: The aim of the study was to assess visual outcome at the last visit (≥8 weeks) following posterior capsule rupture (PCR) in patients who had manual small incision cataract surgery (MSICS) managed without access to an automated vitrector. Minimizing complications will improve visual outcome of cataract patients and increase uptake of cataract surgical services

Objectives

Methods

Results

Discussion

Conclusion