Conventional Extracapsular Cataract Extraction Research Articles

Phacoemulsification Plus Intraocular Lens Implantation with Gold Nanoparticles for Complicated Cataract Secondary to Uveitis: Efficacy Analysis

This study analyzes the efficacy of phacoemulsification (PE) plus intraocular lens implantation (IOLI) in patients with complicated cataracts secondary to uveitis. Nanostructured photothermal ring integrated (nano)-intraocular lens (IOLs) were developed to improve the biocompatibility and optical properties of IOLs. However, data on the safety profile and effectiveness of IOLI for patients with complicated cataracts secondary to uveitis are scarce, and studies have questioned the safety of PE in patients undergoing cataract surgery. We used gold nanoparticle (AuNP)-modified commercially available intraocular IOLs combined with PE technology to treat patients with complicated cataracts secondary to uveitis. First, we found that AuNP-modified IOLs were effective in reducing macrophage and bacterial adhesion and were biocompatible with the organism. Then, 64 patients with complicated cataracts secondary to uveitis were totally selected from February 2019 to February 2022, of which 33 cases were treated with PE+IOLI (test group) and 31 with conventional small-incision extracapsular cataract extraction (SIECCE) and IOLI (control group). Intergroup comparisons based on efficacy, safety, visual acuity (VA), aqueous humor protein levels before and after treatment, and quality of life (assessed with the Generic Quality of Life Inventory-74, GQOLI-74) revealed higher overall treatment efficacy and postoperative VA, as well as lower complication rate and postoperative aqueous humor protein levels, in the test group than the control group. Moreover, the test group had higher GQOLI-74 scores in the dimensions of physical function, mental health, psychological health, and social competence than the control group. Thus, PE+IOLI is more suitable for patients with complicated cataracts secondary to uveitis than conventional SIECCE+IOLI. PE+IOLI can improve treatment efficacy and safety, as well as patient VA and quality of life.

SCLERAL TUNNEL COMPLICATIONS OF SMALL INCISION CATARACT SURGERY

Cataract surgery is one of the most commonly performed surgeries in the world. The various techniques of cataract surgeries are- conventional extracapsular cataract extraction, small incision cataract surgery and phacoemulsification. Although the developing countries have shifted to phacoemulsification, SICS is still a widely 1,2 performed surgery in the developing world. SICS continues to prove useful in the developing countries where cost constraints are a factor in delivery of sight saving cataract 3 surgery. The results of SICS compares favorably with modern 4,5 phacoemulsification surgery. However there are various complications associated with SICS:1. Tunnel related complication (Premature entry and button hole) 2. complication during capsulorhexis- too small rhexis or extension of rhexis margin 3. Posterior capsular rupture 4. Descmet membrane tear 5. Zonular dialysis 6. Nucleus drop. Tunnel construction is a crucial part of SICS. A scleral tunnel; 5.5-7.5mm in length, 1.5 to 2mm behind the limbus, half to two third of scleral thickness, extending 1-2mm in cornea, with side pockets in sclera is self sealing in nature and requires no .6 sutures at the end of surgery Poorly constructed leads to button hole, premature entry into anterior chamber causing iris prolapse or nucleus may get stuck during delivery. In this case series we will discuss three cases who came to the clinic with late presentation of scleral tunnel related complication after SICS.

Outcome of Phacoemulsification and Extracapsular Cataract Extraction

Objective: Aim was to compare the visual results of patients who received ECCE and phacoemulsification for the treatment of age-related cataracts. Study Design: Prospective study Place and Duration: Conducted at Jinnah International Hospital during from Jan, 2021 to Dec, 2021. Methods:There were 130 patients of both genders presented for cataract surgery. Patients were aged between 35-75 years.When patients signed an informed permission form, demographic information such as age and sex were recorded. Patients were equally divided in two groups. Group I received phacoemulsification (phaco) cataract surgery and group II received conventional extracapsular cataract extraction. Intraoperative and post-operative complication among cases was assessed. At last follow up best corrected visual acuity was assessed and compared among both groups. SPSS 24.0 was used to analyze complete data. Results:Among 130 cases, majority of the cases 85 (65.4%) were males and 45 (34.6%) were females. 15 (11.5%) patients were aged between 35-45 years, 45 (34.6%) patients were aged between 46-55 years, 38 (29.2%) were aged between 56-6 years and 32 (24.6%) had age > 65years. Post-operative we found significantly good vision among patients of phaco group in 54 (83.1%) cases as compare to group II in 31 (47.7%) cases. Frequency of intraoperative complications was higher in group II 9 (13.8%) as compared to group I 3 (4.6%) cases. Post-operative complications in group I was corneal decompensation, high astigmatism and posterior capsule opacity but in group II high astigmatism and corneal decompensation were the complications. Conclusion:We came to the conclusion that the visual outcome was considerably better in the Phaco operation compared to the ECCE technique (p = 0.003). As a result, we advocate for the provision of Phaco equipment in hospitals that have sufficient capabilities for the performance of intraocular surgery. Keywords:PhacoemulsificationSurgery, Extracapsular cataract extraction, Complications, Vision Acuity

Comparative Study between Corneal Topographic Changes Following Phacoemulsification and Small Incision Cataract Surgery

Background: Phacoemulsification has become the routine procedure for cataract extraction for most of the surgeons because of its smaller incision and rapid visual rehabilitation. Also, manual small incision cataract surgery (MSICS) with its sutureless relatively smaller incision, compared to conventional extracapsular cataract extraction, has similar advantages to phacoemulsification in addition to its lower risk to corneal endothelium especially in hard cataracts and elder patients. Objective: To compare the effect of phacoemulsification and small incision cataract surgery on corneal topography in a prospective randomized study. Patients and methods: 80 eyes were included in this study. Patients were divided into two groups: Group A (40 eyes) underwent phacoemulsification and Group B (40 eyes) underwent MSICS. Both groups were studied preoperatively and postoperatively regarding uncorrected visual acuity (UCVA), best corrected visual acuity (BCVA), keratometry, and corneal topography. Results: There was a significant difference between preoperative and postoperative uncorrected visual acuity (UCVA) during the follow up period (p value < 0.001) among both study groups. There was no significant difference in preoperative as well as postoperative intraocular pressure (IOP) or between preoperative and postoperative IOP values in both study groups. There was significant increase in the mean central corneal thickness during first postoperative week in both studied groups (p value <0.001). In MSICS group there was minimal significant increase in astigmatism within the first weak and first month of follow up (p value 0.041). Conclusion: Cataract surgery using phacoemulsification or small incision cataract surgery was found to yield excellent visual results with no significant difference as regards to central corneal thickness, keratometric readings, and postoperative astigmatism or perioperative complications.

Comparison of surgically induced astigmatism and visual outcome in 5.5 mm and 4.5 mm superior scleral incision in small-incision cataract surgery

Background: Comparative study of visual outcome and astigmatism between manual small-incision cataract surgery (MSICS) done through a 5.5 mm and 4.5 mm superior scleral incision. Aim: The aim of this study is to compare the visual outcome and astigmatism in manual small-incision cataract with superior scleral incision size of 4.5 mm and 5.5 mm. Settings and Design: This is a hospital-based, prospective, case–control observational study of 6-month duration; 110 eyes of 110 patients with cataract attending the ophthalmology outpatient department/inpatient department at Acharya Vinoba Bhave Rural Hospital were selected for the study after taking the inclusion and exclusion criteria into consideration. Informed consent was obtained from all participants after approval by the institutional ethical committee of the college. Materials and Methods: After enrollment, the patients were divided into two groups, one which underwent cataract extraction by MSICS with 4.5 mm superior scleral incision and the other which underwent cataract extraction by MSICS with 5.5 mm superior scleral incision. All surgeries were done by the same surgeon under the same setting and visual outcome and astigmatism were studied and compared between the two groups. Statistical Analysis Used: Statistical analysis was carried out using descriptive and inferential statistics using Chi-square test and Student's unpaired t-test and software used in the analysis was SPSS 17.0 version and GraphPad 6.0 version and P < 0.05 is considered a level of statistical significance. Results: Surgically induced astigmatism (SIA) in MSICS with 4.5 mm superior scleral incision was comparatively less as compared to that in patients in whom 5.5 mm incision was used. Conclusions: In the present study, we found that MSICS with 4.5 mm scleral incision has a better visual prognosis for cataract extraction as compared to conventional extracapsular cataract extraction in terms of better and early visual rehabilitation and lesser SIA.

Comparative study of visual outcome, astigmatism, and complications between conventional extracapsular cataract extraction and manual small incision cataract surgery

Context: Comparative study of visual outcome, astigmatism, and complications between conventional extracapsular cataract extraction (CECCE) and manual small incision cataract surgery (MSICS). Aims: To study and compare the visual outcome, astigmatism, and complications between CECCE and MSICS. Settings and Design: This is a hospital-based, prospective, case–control observational study of 2 years' duration; 110 eyes of 110 patients with cataract attending the ophthalmology outpatient department/inpatient department at Acharya Vinoba Bhave Rural Hospital were selected for the study after taking the inclusion and exclusion criteria into consideration. Informed consent was obtained from all subjects after approval by the institutional ethical committee of the college. Materials and Methods: After enrollment, the patients were divided into two groups, one which underwent cataract extraction by CECCE and other which underwent cataract extraction by MSICS. All surgeries were done by the same surgeon under same setting, and visual outcome, astigmatism, and complications were studied and compared between the two groups. Statistical Analysis Used: Statistical analysis was carried out using descriptive and inferential statistics using Chi-square test and Student's unpaired t-test and software used in the analysis was SPSS 17.0 version and Graph Pad 6.0 version and P

COMPARISON OF POST OPERATIVE CORNEAL ASTIGMATISM BETWEEN SMALL INCISION CATARACT SURGERY (SICS) AND EXTRA CAPSULAR CATARACT EXTRACTION (ECCE)

Background&#x0D; Cataract surgery is the most common type of surgery done by ophthalmologists. There are many methods of performing cataract surgery. Each of them has its own advantages and complications. Here we want to find the outcome of both the manual small incision cataract surgery and the conventional extracapsular cataract extraction surgery. &#x0D; Objectives &#x0D; To find the degree of postoperative corneal astigmatism in both manual small incision cataract surgery and the extracapsular cataract extraction surgery and compare these outcomes in both techniques.&#x0D; Patients and Methods&#x0D; We performed an experimental study conducted from January 2016 to June 2016 in Shahid Dr.Aso hospital ophthalmology department and Best Vision private hospital, Sulemani Province/Kurdistan Region of Iraq. One hundred cases were enrolled in the study, 50 cases underwent manual small incision cataract surgery and the other 50 underwent extracapsular cataract extraction surgery. All patients had their history taken, preoperative evaluation by (Slit-lamp examination, intraocular pressure measurement, indirect ophthalmoscopy for fundus examination, intraocular lens measurement, B-scan). Postoperatively; after 2 months, all cases in both groups were re-evaluated by the same measures of the preoperative examination.&#x0D; Results&#x0D; The mean postoperative uncorrected visual acuity in the manual small incision cataract surgery and extracapsular cataract extraction group was 6/9 and 6/12, respectively. The mean postoperative corneal astigmatism was 1.27+0.94 in manual small incision cataract surgery compared to 2.59+1.65 in the extracapsular cataract extraction surgery.&#x0D; Conclusion&#x0D; Both manual small incision and extracapsular cataract extraction techniques are safe and effective for visual rehabilitation of cataract patients. However, manual small incision cataract surgery gives better uncorrected visual acuity and less induced corneal astigmatism at 8 weeks postoperatively.

A comparative study of astigmatism following manual small incision cataract surgery and conventional extracapsular cataract extraction at a tertiary centre in northern india

Objective: To compare the surgically induced astigmatism following two different techniques of cataract surgery-manual SICS (Small Incision Cataract Surgery) and standard ECCE (Extra-Capsular Cataract Extraction). Materials and Methods: Subjects consisted of patients, aged 10-80 years, from both sexes and divided into two groups of 100 each (one eye per patient). One group was operated with manual SICS and the other with standard ECCE technique. Results: The mean surgically induced astigmatism (SIA) in the SICS group during the sixth week postoperative follow up was found to be 0.66D ± 0.60 SD (Standard Deviation) compared to 2.25D ± 1.23 SD in the ECCE group. At 6th week follow up, no patient in the SICS group had SIA more than 3D whereas in the ECCE group 30% of the patients had astigmatism >3 D. The induced astigmatism between the two groups had a p-value of <0.001 which is highly significant. Conclusions: It is concluded that SICS induces less surgically induced astigmatism, less inflammation, less complications influencing the overall visual prognosis and quick stabilization of refraction, hence providing better and rapid visual rehabilitation in the postoperative period as compared to the patients in the ECCE group.

A comparative study of astigmatism following manual small incision cataract surgery and conventional extracapsular cataract extraction at a tertiary centre in northern india

A comparative study of astigmatism following manual small incision cataract surgery and conventional extracapsular cataract extraction at a tertiary centre in northern india

A randomized controlled trial of peeling and aspiration of Elschnig pearls and neodymium: yttrium-aluminium-garnet laser capsulotomy.

To compare surgical peeling and aspiration and neodymium yttrium garnet laser capsulotomy for pearl form of posterior capsule opacification (PCO). A prospective, randomized, double blind, study was done at Rotary Eye Hospital, Maranda, Palampur, India, Santosh Medical College Hospital, Ghaziabad, India and Laser Eye Clinic, Noida India. Consecutive patients with pearl form of PCO following surgery, phacoemulsification, manual small incision cataract surgery and conventional extracapsular cataract extraction (ECCE) for age related cataract, were randomized to have peeling and aspiration or neodymium yttrium garnet laser capsulotomy. Corrected distance visual acuity (CDVA), intra-operative and post-operative complications were compared. A total of 634 patients participated in the study, and 314 (49.5%) patients were randomized to surgical peeling and aspiration group and 320 (50.5%) to the Nd:YAG laser group. The mean pre-procedural logMAR CDVA in peeling and neodymium: yttrium-aluminium-garnet (Nd:YAG) laser group was 0.80±0.25 and 0.86±0.22, respectively. The mean final CDVA in peeling group (0.22±0.23) was comparable to Nd:YAG group (0.24±0.28; t test, P=0.240). There was a significant improvement in vision after both the procedures (P<0.001). A slightly higher percentage of patients in Nd:YAG laser group (283/88.3%) than in peeling group (262/83.4%) had a CDVA of 0.5 (20/63) or better at 9mo (P<0.001). On the contrary, patients having CDVA worse than 1.00 (20/200) was also significantly higher in Nd:YAG laser group as compared to peeling group (25/7.7% vs 15/4.7%, respectively). On application of ANCOVA, there was less than 0.001% risk that PCO thickness and total laser energy had no effect on rate of complications in Nd:YAG laser group and less than 0.001 % risk that PCO thickness had no effect on complications in peeling group respectively. Sum of square analysis suggests that in the Nd:YAG laser group, thick PCO had a stronger impact on complications (Fischer test probability, Pr<0.0001) than thin PCO and total laser energy (Fischer test probability, Pr<0.002), respectively; similarly, in peeling group, thick PCO and preoperative vision had a stronger effect on complications than thin PCO, respectively (Fischer test probability, Pr<0.001).The rate of complications like uveitis (P=0.527) and cystoid macular edema (P=0.068), did not differ significantly between both the groups. However, intraocular pressure spikes (P=0.046) and retinal detachment (P<0.001) were significantly higher in Nd:YAG laser group as compared to peeling group. Retinal detachment was more common in patients having degenerative myopia (7/87.5%, P<0.001). Recurrence of pearls was the most common cause of reduction of vision in the peeling group (24/7.6%, P<0.001). There is no alternative to Nd:YAG laser capsulotomy for fibrous subtype of PCO. For pearl form of PCO, both techniques are comparable with regard to visual outcomes. Nd:YAG laser capsulotomy has a higher incidence of IOP spikes and retinal detachment whereas recurrence of pearls may occur after successful peeling and aspiration. When posterior capsulotomy is needed in patients with retinal degenerations, retinopathies and pre-existing retinal breaks, the clinician should be cautious about increased risks of possible complications of Nd:YAG laser capsulotomy.

Comparison of visual outcome between conventional extracapsular cataract extraction and phacoemulsification cataract surgery

Objectives: To compare visual outcomes in patients who had conventional extracapsular cataract extraction (ECCE) and phacoemulsification for age-related cataract.Materials and Methods: Prospective study comparing the visual outcomes in 360 eyes of 352 patients, 180 of whom were randomized to conventional ECCE and the remaining 180 to phacoemulsification cataract surgery. Visual acuity was assessed on day 1, 1 week, 4 weeks, and 12 weeks postoperatively.Results: In the EECE group, good presenting visual acuity of 6/18 or even better was found in 6%, 31%, 46%, and 69% patients at 1-day, 1-week, 4-week, and 12-week postoperative intervals, respectively. In the phacoemulsification group, visual acuity of 6/18 or even better was achieved in 48%, 78%, 82%, and 89% patients, respectively, at the same postoperative interval as the ECCE group. This difference was statistically significant at all the postoperative intervals.Conclusion: Phacoemulsification achieves better postoperative visual acuity at the early and intermediate postoperative periods. Availability of this technique of cataract extraction will enhance eye care in our various institutions.

Conventional extracapsular cataract extraction and its importance in the present day ophthalmic practice.

Purpose:A retrospective study aimed to evaluate high risk cases where conventional Extracapsular cataract extraction (ECCE) was performed, their intra-operative and post-operative outcomes.Setting:Sri Srinivasa Sankara Nethralaya (Tirupati) Tirumala Tirupati Devastanams Central Hospital, Tirupati, India.Subjects and Methods:Retrospective study of 207 patients who underwent ECCE at the hospital between august 2010 to June 2012. Operative data included details like grade of risk, intra and postoperative complications and visual outcome.Results:Out of 207 cases, 188 were in group 3 (moderate risk, 3-5 points) and 19 in group 4 (high risk, 6 points or more). The intra operative complications in group 3 were 8 (0.042%) and none in group 4. Final best corrected visual acuity (BCVA) of 6/12 and more were 184 (88.88%). Final refraction of less than 2.0 astigmatism was seen in 80.19% (n=166).Conclusion:Segregation of cases depending on the risk factors can lead to lower intra operative complications and therefore good postoperative outcome. We believe that phacoemulsification, manual small incision cataract surgery (MSICS) and ECCE each has its own importance and should be used as per the cataract with risk factors.

Surgical outcome of triple procedure as penetrating keratoplasty with extracapsular cataract extraction with posterior chamber intraocular lens implantation in patients with both central corneal opacity and advanced cataract at rural set UP

Purpose: To study the surgical outcome of triple procedure as penetrating keratoplasty (PKP) with conventional extra capsular cataract extraction (ECCE) with posterior chamber intraocular lens (PCIOL) implantation in patients with both central corneal opacity and advanced cataract at rural set up. Introduction: When corneal opacity and cataract present together then wellestablished and effective triple procedure is indicated. Prognosis for a clear graft is good in triple, as graft endothelium does not touch the hard nucleus which may occur in two steps or sequential surgery. It provides faster visual rehabilitation. Being single step procedure it reduces patient’s hospital stay, postoperative care and follows up visits. Methodology: In this hospital based observational , three years longitudinal study, we studied the surgical outcome of relatively rare one step triple procedure as PKP with conventional ECCE with PCIOL implantation in sulcus or in bag, in patients with both central corneal opacity and advanced cataract at rural set up. The outcome measures included graft clarity on slit lamp, postoperative unaided visual acuity with Snellen’s chart and the occurrence of postoperative complications after taking IEC permission and informed written consent in local language from study patients. Results: Out of 13 study patients mean age was 61.15yrs (Range50-80yrs). Follow up range was 9-34 months. At final follow up 9 patients (69.23%) had clear grafts and 61.52% patients gained visual acuity >6/24. Graft failure was the most common post operative complication in 30.76% followed by Posterior capsular opacification (PCO) in 15.38% patients which was treated well with YAG laser capsulotomy. Conclusion: Triple procedure gives good results in respect to graft clarity, unaided vision, and faster rehabilitation.

Outcomes and Barriers to Uptake of Cataract Surgery in Rural Northern China: The Heilongjiang Eye Study

Purpose: To report visual outcomes and barriers to uptake of cataract surgery among subjects of all ages in Mingshui County, Heilongjiang Province, China.Methods: Cluster sampling was used to select a cross-sectional sample of people living in the Heilongjiang Province. Each subject underwent a participant interview, presenting and best-corrected vision measurements and an ocular examination. Visual outcomes and barriers to uptake of cataract surgery were assessed among subjects undergoing cataract surgery. Individuals who needed cataract surgery were interviewed regarding barriers.Results: Of 11,787 subjects, 10,384 eligible participants underwent visual acuity (VA) testing and a basic eye examination (88.1% response rate). The cross-sectional sub-sample of 21 participants receiving cataract surgery had a median age of 63 years. Six eyes undergoing surgery at the county hospital with conventional intracapsular and extracapsular cataract extraction without an intraocular lens implant were aphakic, and 15 eyes (71.4%) undergoing surgery at tertiary care hospitals were pseudophakic. Seven eyes (33.3%) had corrected VA ≥ 20/60, and nine eyes (42.9%) had presenting VA ≥ 20/60. Approximately 28.6% (6/21) had poor outcomes. The principal causes of presenting blindness after cataract surgery were refractive error/uncorrected aphakia and posterior capsular opacification. Cost was the most common barrier (73.9%) to uptake of cataract surgery.Conclusions: Cataract surgical outcomes in northern China were poor. The principal barrier to uptake of cataract surgery was cost. These findings call for the establishment of cataract surgical services that are of high quality, affordable, and sensitive to high-risk groups.

Comparison of small incision cataract surgery with conventional extra capsular cataract surgery: an evaluation from resource poor setting in India

Background: Cataract is the chief cause of avoidable blindness in the developing countries of the world including India. These patients can regain normal sight with the help of cataract surgery, which has undergone many advances and Small Incision Cataract Surgery (SICS) has gained wide acceptance world over as the surgical method requires minimal infrastructure. The present study compares it’s safety profile for the patients as well as acceptability amongst the doctors performing conventional Extra Capsular Cataract Extraction (ECCE) surgery in peripheral resource poor settings. Methods: All patients having cataract were examined prior to surgery and were randomized in two groups: group I - small incision cataract surgery and group II - conventional extra capsular cataract extraction surgery with posterior capsular intra ocular lens implantation. The various intra and post-operative complications were evaluated. Results: 252 eyes of 252 patients were enrolled with 121 patients in group I and 131 patients in group II and intra-operative and post-operative complications compared. Intra-operatively difficulty in nucleus delivery was higher in group I (12.3%) whereas repeated iris protrusion (12.5%) and posterior capsular rent (8.3%) was higher in group II. Postoperatively, on day 1 striate keratopathy was commoner in group I (20.6%) whereas uveitis was seen more commonly (26.7%) in group II. At 6 weeks, surgically induced astigmatism was higher (61%) in group II as compared to group I (35%). Conclusion: SICS is a safe and acceptable alternative to conventional ECCE in a peripheral teaching setup.

Gonioscopic changes in conventional ECCE vs manual SICS: A comparative study

The aim of the study is to observe and compare the Gonioscopic changes in the angle of the anterior chamber of the eye after surgeries namely; Conventional Extra capsular cataract extraction (ECCE) with Posterior chamber Intraocular lens (PC IOL) implantation, Manual Small incision Cataract Surgery with PCIOL implantation. The clinical study was undertaken after Institutional Ethical committee clearance, securing the inform consent, total number of 100 patients were enrolled in the study. 50 ECCE; 50 SICS consisting of 57 Males and 43 Females aged between 40 -80yrs who were admitted and operated for Cataract at Meenakshi Medical college Hospital & Research institute. The following parameters are studied: Gonioscopic changes in the angle, namely the PAS formation in the quadrants, pigment dispersion in each of the methods. After this study, we arrive to a conclusion that complications in the angle of anterior chamber occur mostly in Conventional with insignificant change in manual SICS. So manual Small incision Cataract Surgery with PCIOL implantation is preferable over Conventional ECCE with PCIOL implantation.

Life quality assessment of patients after phacoemulsification or extracapsular cataract extraction.

To study the quality of life, treatment outcomes, and satisfaction in patients who have undergone cataract surgery Methods: This comparative case series study was conducted at the Ophthalmology Service of the Bettina Ferro de Souza University Hospital, Belém, Pará, Brazil. Totally, 60 patients with cataract were included; 50% underwent conventional extracapsular cataract extraction (ECEE) and 50% underwent cataract extraction by phacoemulsification (PHACO). Patients were interviewed using the Visual Function 14 (VF-14) questionnaire to determine the quality of life before and 30 days after surgery. The results of ophthalmological examination were recorded in the patients' files and were available throughout this study. One-way ANOVA, Tukey's post-hoc comparison, and the sign test were used for statistical analyses. The mean VF-14 satisfaction index was 38.0 and 89.4 before and after surgery, respectively, for the ECEE group and 47.0 and 94.1, respectively, for the PHACO group. The improvement in patient quality of life after surgery was significant in both groups (p<0.0001), with a similar amount of improvement in both groups. The observed improvement in quality of life was significant (p<0.0001) and directly related to patient satisfaction with surgical outcomes, which was also significant (p<0.0001) as assessed using the VF-14. Satisfaction and quality of life are individual factors; consequently, patient responses to questions regarding improvements in the ability to perform each activity are subjective and depend uniquely on individual perception.

Phacoemulsification and intraocular lens implantation in cataract after glaucoma surgery

Objective To evaluate the clinical effect of combined phacoemulsification and foldable intraocular lens implantation for patients after glaucoma surgery. Methods 88 cases （90 eyes） of cataract patients after glaucoma surgery were randomly divided into treatment group （43 cases 45 eyes） and control group （45 cases 45 eyes）. Transparent cornea incision phaeoemulsification and foldable intraocular lens im- plantation were performed in the treatment group. Conventional extracapsular cataract extraction technique was used in the control group. The visual acuity and corneal astigmatism were measured at postoperative 1 week, I month and 3 months. Results The patients of uncorrected visual acuity over 0.5 in treatment group were more than that in control group 1 week, 1 month and 3 months after operation （P 〈 0.01 ）. 3 months af- ter surgery, there were statistical signifieant difference in the average changes of corneal astigmatism between two groups （P 〈 0.01 ）. Conclusion Transparent corneal incision phacoemulsification and foldable intraoc- ular lens implantation had good clinical efficacy after glaucoma surgery, and better visual acuity and less postoperative astigmatism can be obtained. Key words: Anti-glaucoma surgery ; Phacoemulsification; Cataract; Lens, intraoeular

Structured extracapsular cataract extraction-intraocular lens microsurgical training: Report of a trainee′s experience

The aim was to report the experience an ophthalmologist gained in a structured intraocular lens (IOL) microsurgery training program for the information and benefit of colleagues in ophthalmology training institutions. An ophthalmologist was trained in extracapsular cataract extraction (ECCE)-IOL implant in Aravind Eye Hospital (AEH), Madurai, for a period of 8 weeks. Details of patients operated on, procedures observed, and conferences attended were prospectively recorded in a log book. Training was available in conventional ECCE with posterior chamber IOL (ECCE-PCIOL), small incision sutureless cataract surgery, and phacoemulsification. During the period, this trainee observed a total of 1527 cataract extractions, administered 528 retrobulbar and 1047 facial blocks, and also operated on 75 patients. The trainee gained experience and confidence to perform high-quality, low-cost cataract surgery. Hands-on experience and competence in quality ECCE-IOL implant microsurgery can be acquired in a short period of time in a high-volume cataract center. Trainees can also be exposed to other techniques of cataract surgery. Ophthalmology training centers with diminishing surgical training opportunities can also benefit from this structured training in a high-volume cataract center like Aravind Eye Hospital.

Systemic Absorption of Triamcinolone Acetonide after Posterior Sub-Tenon Injection

To study systemic absorption of triamcinolone acetonide (TA) after posterior sub-Tenon injection. Prospective, interventional case series. The study was conducted in a tertiary care teaching hospital on 35 eyes in which posterior sub-Tenon injection of 40 mg TA was administered after conventional extracapsular cataract extraction. Patients who had received any systemic steroid over 6 weeks preceding the period of study or had inflammatory ocular conditions were excluded. Serum TA levels were estimated by high-performance liquid chromatography at 1, 2, 3, 24, and 48 hours and 1, 2, and 6 weeks after injection. Significant levels of the drug were detected in 45.71% of samples (mean serum levels, 6.94 +/- 8.98 ng/ml; P < .001) at 1 hour after sub-Tenon injection, in 85.71% of samples (mean serum levels, 21.83 +/- 12.92 ng/ml; P < .001) at 2 hours after injection, in 100% of samples (mean serum levels, 47.14 +/- 12.20 ng/ml; P < .001) at 3 hours after injection, in 100% of samples (mean serum levels, 35.49 +/- 13.79 ng/ml; P < .001) at 24 hours after injection, in 62.86% of samples (mean serum levels, 10.46 +/- 10.69 ng/ml; P < .001) at 48 hours after injection, and in 28.57% of samples (mean serum levels, 3.74 +/- 6.45 ng/ml; P = .002) at 1 week after injection. The drug was not detected in any of the samples obtained 2 weeks and 6 weeks later. Posterior sub-Tenon injection of 40 mg TA adds statistically significant quantities to physiologic concentration of corticosteroids in peripheral blood. This may be detrimental for patients having certain metabolic diseases like diabetes and preferably should be avoided or administered with caution.