Number Of Cataract Surgeries Research Articles

Assessing the cataract surgical rate and gender equity in cataract services in south-east Nigeria

BackgroundIn 2020, almost 100 million people were blind or visually impaired from cataract. Cataract surgery is a cost-effective treatment for cataracts. In Nigeria, twice as many women are cataract blind...

Examination of phacoemulsification tips after different numbers of cataract surgeries

To compare unused phacoemulsification tips and those used different times with different techniques of cataract surgery (divide and conquer and chop), in vivo phacoemulsifications were performed with tips of different numbers of operation. These were compared with the same number of sterilized-only and unused tips with the help of an atomic force microscope. Comparison of roughness values (Sa, Sq), geometric and measurable flange length and surface was also performed (profile length %, area %). The differences between the parameters that can be measured during surgery (average ultrasound percentage, US ave %, Average Phaco Time, APT) were also analyzed. We found significant correlations between age and lens hardness (p = 0.0045), area % and APT (p = 0.03), between area % and US ave% (p = 0.03) and also between the two surgical techniques in terms of area% (p = 0.04) and US ave % (p < 0.01). Roughness increased with the number of uses. An increase in profile length% can be observed up to the twentieth operation. This can result from scratches and microscopic damages and also from abrasion and possible material additions on the surface of the needles. The divide and conquer technique causes less microscopic damage to the surface, and smaller average US energy is required during surgery.

Progression in the Number of Cataract Surgeries in Brazil: 10 Years of Evolution

ABSTRACT Objective This study aimed to assess the frequency of cataract surgery in Brazil between 2010 and 2019 and determine the impact of public policies on preventing blindness, thereby providing evidence to conduct healthcare programs. Methods An analytical epidemiological approach was employed, which used data from public databases, specifically the Hospital Information System (SIH-SUS) and the Outpatient Information System (SIA-SUS). We focused on cataract surgeries conducted via phacoemulsification and extracapsular cataract extraction techniques between 2010 and 2019, mainly targeting senile cataracts within the Brazilian public health system. Data were analyzed on an annual basis and stratified by region. Trends over time were assessed using generalized additive models. Results A statistically significant upward trend in cataract surgeries was observed both nationally and within the South region (p < 0.05). Nationally, there was a 40.22% increase in surgeries between 2010 and 2019. Furthermore, the surgery rate per 1000 individuals aged ≥50 years varied across regions: nationally, it was 10.85, with rates of 9.23 in the Southeast, 13.86 in the Northeast, 9.23 in the South, 11.94 in the Midwest, and 14.2 in the North. Conclusion All regions of the country, a satisfactory number of cataract surgeries were performed at some point. Only the Southern region demonstrated a notable upward trend in the number of cataract surgeries. Conversely, the remaining regions failed to sustain surgical performance, hindering consistent improvement in cataract-related conditions. To accurately gauge the prevalence of blindness in Brazil, it is crucial to examine the population growth among individuals aged ≥50 years.

An epidemic of cataract surgery in Korea: the effects of private health insurance on the National Health Insurance Service.

In Korea, the National Health Insurance Service (NHIS) covers essential healthcare expenses, including cataract surgery. To address concerns that private health insurance (PHI) might have inflated the need for such procedures, we investigated the extent of the PHI-attributable increase in cataract surgery and its impact on NHIS-reimbursed expenses. This retrospective, observational study uses nationwide claims data for cataract surgery from 2016 to 2020. We examined trends in utilization and cost, and we estimated the excess numbers of (1) cataract operations attributable to PHI and (2) types of intraocular lenses used for cataract surgery in 2020. Between 2016 and 2020, a 36.8% increase occurred in the number of cataract operations, with increases of 63.5% and 731.8% in the total healthcare costs reimbursed by NHIS and PHI, respectively. Over a 5-year period, the surgical rate per 100,000 people doubled for patients aged <65 years (from 328 in 2016 to 664 in 2020). Among the 619,771 cases in 2020 of cataract surgery reimbursed by the Korean diagnosis-related group system, more non-NHIS-covered intraocular lenses were used for patients aged <65 years than ≥65 years (68.1 vs. 14.2%). In 2020 alone, an estimated 129,311 excess operations occurred, accounting for an excess cost of US$115 million. A dramatic increase in the number and cost of cataract operations has occurred over the last 5 years. The PHI-related increase in operations resulted in increased costs to NHIS. Measures to curtail the non-indicated use of cataract surgery should be implemented regarding PHI.

Impact of the COVID-19 pandemic on cataract surgeries in Brazil: A retrospective study

PurposeThis study aimed to describe the behavioral patterns of data on cataract surgery performed in the Brazilian public health system before, during, and after the COVID-19 outbreak and estimate the setbacks generated by the pandemic to guide public policies. Materials and methodsThis was an observational, longitudinal, and descriptive epidemiological study based on data retrieved from the public health system's databases of cataract surgeries performed each year and in each region from 2015 to 2022. ResultIn Brazil, compared with the average of the 5-years preceding the pandemic, a 23 % reduction in the number of cataract surgeries was observed in 2020, followed by a 21 % increase in 2021, compensating for the majority of patients that were not operated on. However, the worsening situation of blindness caused by cataracts due to the pandemic not be avoided in the Central-West region, where unrecovered cases continue to accumulate. ConclusionThe COVID-19 pandemic did not worsen the situation of cataract blindness in Brazil due to the efficacy of the measures taken by the government in resuming elective surgeries. However, the auhtors recommend that the distribution of resources for cataract surgeries should consider regional discrepancies based on epidemiological data.

Governmental support for achieving “VISION 2020: the Right to Sight” in Iran: the cataract surgical rates

PurposeThe aim of this study was evaluate the effect of governmental support in the form of Health Transformation Plan (HTP) on increasing the cataract surgical rate.MethodsThe number of cataract surgeries was collected from Iranian cataract surgery clinics during 2019. HTP was implemented in 2014. Forty-seven major and forty-five minor surgery centers were selected from all provinces. In each center, sampling was done from 2012, 2013, 2015, and 2016.ResultsOn average, 6202 and 7134 cataract surgery rate were performed before and after HTP, respectively. The cataract surgical rate rose by 15.03% after the HTP. After HTP, the proportion of cataract surgery increased by 21.32% in governmental centers and decreased by 17.56%, 24.45%, and 14.89% in private, insurance, and charity centers, respectively. The cataract surgical rate was 4093 and 6026 in the first economic quartile (the poorest), 3669 and 4595 in the second quartile, 5884 and 5928 in the third quartile, and 8427 and 9681 in the fourth quartile (the richest) before and after HTP, respectively. The highest growth in the cataract surgical rate was seen in the first quartile (47.24%) followed by the second (25.26%), fourth (14.88%), and third quartiles (0.74%).ConclusionThe Health Transformation Plan has been successful in increasing the cataract surgical rate in the low-income group and identifying differences in the services as well as the economic groups within the population.

Cataract Surgery during the COVID-19 Pandemic: Insights from a Greek Tertiary Hospital.

Background: COVID-19 has affected everyday clinical practice, having an impact on the quality of healthcare provided, even in eye clinic departments. The aim of this study is to evaluate the consequences of this worldwide pandemic on cataract surgery in a Greek tertiary university hospital. Methods: A total of 805 patients were included in this study. The number of cataract surgeries (CS), the type, the unilateral or bilateral appearance as well as the stage of cataract were recorded for the months between January and June 2019 (pre-COVID period) and compared with the same period in 2021 (during the pandemic outbreak) in the Department of Ophthalmology of Thessaloniki General Hospital G. Papanikolaou. Results: A significant reduction in the number of CS as well as a significant increase in advanced and/or bilateral cataracts in 2021 compared to the pre-COVID period were observed. Conclusions: The COVID-19 pandemic has affected equally the value of ophthalmic interventions as well as the patients’ quality of life, being a powerful reminder of the significant physical and psychological benefits of CS, especially for older adults and patients with comorbidities.

Incidence, Prophylaxis and Prognosis of Acute Postoperative Endophthalmitis After Cataract Surgery: A Multicenter Retrospective Analysis in Northern China from 2013 to 2019.

ObjectiveTo investigate the incidence of acute postoperative endophthalmitis (POE) after cataract surgery in Northern China from 2013 to 2019, evaluate the efficacy of prophylaxis and analyze the predictors of visual prognosis among POE patients.MethodsThe study was conducted as a retrospective multi-center research, with seven hospitals in Northern China enrolled. The diagnosis of acute-onset POE was made on the basis of clinical manifestations within six weeks after initial surgery. By reviewing electronic medical system, the number of cataract surgeries and acute POE cases were recorded to estimate the overall incidence and incidences by different years and hospitals. Perioperative measures for preventing infection in different hospitals were collected. The correlations between unfavorable final vision and potential factors including basic information and clinical characteristics were examined to determine the predictive factors for final visual prognosis.ResultsOf 72,255 cataract surgeries performed during seven years in the seven hospitals, 19 cases developed acute POE, yielding an overall incidence of 0.026%. The average incidence of acute POE among seven hospitals significantly declined annually during the past 7 years (p = 0.021). In Hospital-D, the incidence of acute POE significantly decreased after the application of 0.5% povidone-iodine (PVP-I) for conjunctival washing (p = 0.003). Two hospitals adopting tobramycin in the irrigation solution achieved a significant lower incidence of POE than the other hospitals (p = 0.044). The positive rate of pathogen culture was just 17.6% (3/19). Patients with presenting BCVA of CF or better were more likely to present with unfavorable final vision than those with worse presenting BCVA (p = 0.003).ConclusionThe overall incidence of acute POE after cataract surgery from 2013 to 2019 in Northern China was 0.026%, and the incidence declined annually over the period. Presenting BCVA could be a significant prognosis factor for predicting the final visual outcomes of acute POE patients.

Geographic variations in gender differences in cataract surgery volume among a national cohort of ophthalmologists.

To assess factors associated with gender disparities in cataract surgery volume and evaluate how these differences have changed over time. Cataract surgeons in the 2012 to 2018 Medicare database. Retrospective study. The association of provider gender with the number of cataract surgeries per office visit billed was assessed with negative binomial regression models, controlling for calendar year, years in practice, hospital affiliation, geographic region, rurality, density of ophthalmologists, and the national percentile of Area Deprivation Index (ADI) score for the practice location. There were 8480 cataract surgeons, most of whom were male (78%). Male surgeons worked in more deprived areas with a higher ADI (median: 40 vs 33, P < .001). Female surgeons performed fewer cataracts per year (140 [95% CI, 126-154] vs 276 [95% CI, 263-288], P < .001) and billed fewer office visits (1038 [95% CI, 1008-1068] vs 1505 [95% CI, 1484-1526], P < .001). In multivariate analysis, the number of cataract surgeries per office visit was greater for males compared with females in all years in the South (average incidence rate ratio 1.80), Midwest (1.50), and West (1.53), but not in the Northeast (1.16). The relative rate of cataract surgeries between male and female surgeons in each region did not change significantly over time from 2012 to 2018 ( P > .05 in each region). Gender disparities in cataract volume among male and female surgeons have remained unchanged over time from 2012 to 2018. The higher cataract volume among male surgeons may be explained in part by provider practice location. Further studies are needed to better understand and address gender disparities.

Improved clinical outcomes in patients with juvenile idiopathic arthritis associated uveitis in the last decade.

The purpose of the study was to analyse the development of ocular complications and visual prognosis in juvenile idiopathic arthritis associated uveitis (JIA-uveitis) compared to the previous decade in the light of new treatment guidelines. In this retrospective cohort, 143 patients with JIA-uveitis were stratified into two cohorts based on the year of diagnosis of uveitis, <2010 (n = 61) and ≥2010 (n = 82). Development of ocular complications and visual outcomes were analysed by univariate and multivariate methods. Treatment with systemic corticosteroids and immunomodifying medication (IMT) were documented. In total, 109 and 133 affected eyes, respectively, for cohort 1 (<2010) and cohort 2 (≥2010) were included for analysis. In the multivariate analysis with correction for paired eyes, patients in cohort 1 were at higher risk for cataract surgery (p = 0.03) and secondary glaucoma (p = 5.15 × 10-3 ). Also, the number of eyes that were legally blind and visually impaired at 5 years of follow-up was significantly higher in cohort 1 (7% versus 2% and 8% versus 0%, p = 0.01 respectively). The number of patients that started IMT was significantly higher in cohort 2 (57% versus 98%, p = 2.17 × 10-6 ). In cohort 2, both methotrexate and anti-TNF-α therapy were prescribed earlier in the disease course (1.41 versus 0.05 years, p = 8.31 × 10-6 and 6.07 versus 1.84 years, p = 5.14 × 10-5 respectively). The prognosis of JIA-uveitis has improved during the last decade. There is a reduction in the number of cataract surgeries and secondary glaucoma and fewer patients lose their vision parallel with earlier access to tertiary care and earlier introduction of IMT.

WHITE SENILE CATARACTS: INTERMEDIATE ASSESSMENT OF IMPACT OF VISION 2020-THE RIGHT TO SIGHT PROGRAM IN RURAL NORTHERN INDIA

Worldwide cataract is the leading cause of avoidable blindness. In India according to a survey, blindness due to cataract accounts for over 2 seventy percent of avoidable blindness. The goal of vision 2020 1 program is elimination of avoidable blindness. Since cataract is major cause of avoidable blindness in developing countries like India, the key to success of vision 2020 initiative lies in addressing cataract 3 blindness. India is the signatory of vision 2020 program, initiated by World Health Organization (WHO) in 1999. The latest reports assessing impact of the program in India indicate increase in number of 4 cataract surgery rate. The cataract surgery rate (CSR) is the number of cataract surgeries per million populations per year. CSR is an important quantitative measure of cataract surgical service delivery within dened population. However, CSR only partly measure the impact of a program designed to eliminate the avoidable blindness. Another indicator, which measures proportion of persons receiving cataract surgery of the eligible visually impaired individuals, is cataract surgical coverage (CSC). CSC serves as an indicator to measure the extent to which services have covered the need of the 5 population. Most of the published literatures assessing impact of vision 2020 program have focused on CSR, and only few have dealt 6, 7 with CSC. Senile cataracts turning white are consequence of normal maturity process of crystalline lens, and often considered as resultant of delayed cataract surgery. Their prevalence in community is an indirect indicator of impact of program targeting blindness due to cataract. The study was aimed to determine hospital based incidence of white senile cataracts and to nd causes for delay in uptake of cataract surgery

Vitreoretinal Surgery in the Treatment of Dislocations of Intraocular Lens and Nucleus-Lens Particules into the Vitreous Cavity

Drops of lens nucleus/cortex particles into the vitreous cavity or dislocations of intraocular lenses (IOLs) are one of the serious complications of cataract surgery with an increasing relative frequency with the increase in the number of cataract surgeries. In addition, spontaneous and traumatic dislocations are other common case groups that should be treated. In this article, the vitreous dislocations of nucleus/cortex residues or IOL dislocations are discussed with different vitreoretinal surgical techniques.

Хирургия возрастной катаракты в Хабаровском филиале ФГАУ «НМИЦ «МНТК «Микрохирургия глаза» им. акад. С.Н. Фёдорова» Минздрава России

Purpose. To analyze cataract surgery performed in the Khabarovsk branch of the S. Fyodorov Eye Microsurgery Federal State Institution (Khabarovsk branch). Material and methods. The work of the Khabarovsk branch on the treatment of patients with cataracts in 2018–2020 was analyzed on the basis of annual statistical reports submitted to the Head Organization and the Analytical Center of the Ministry of Health of the Khabarovsk krai. Results. Cataract surgery account for more than 30% of the total volume of surgeries performed in 2018–2020. The largest (up to 63%) share of the number of cataract surgery in the structure of the subjects of the Far Eastern Federal District falls on the Khabarovsk krai. To correct aphakia, the Khabarovsk branch currently uses large arsenal of intraocular lenses, which allows satisfying the ever-increasing demands of patients for obtaining high visual functions after surgery. Conclusion. The Khabarovsk branch has all the modern technologies for the surgical treatment of senile cataracts and satisfying the increasing demands of patients for obtaining high visual functions in the postoperative period and is the leader in cataract surgery in the Far Eastern Federal District. Key words: cataract, phacoemulsification, intraocular lens, visual acuity.

Особенности хирургии катаракты в государственном учреждении здравоохранения в период пандемии COVID-19

Purpose. To assess the effectiveness of the KGBUZ «KKOB» in the context of the pandemic of the new coronavirus infection COVID-19 using the example of cataract surgery. Material and methods. Based on regulatory documents aimed at preventing the spread of COVID-19, internal orders were issued that regulated the work of our institution. The actions of the clinic's services were regulated when a building was converted into a «covid hospital», as well as when employees of the institution were transferred to work in a covid hospital. Results. New rules for organizing and conducting medical and diagnostic procedures have been developed. The number of cataract surgeries decreased in 2020 and in the first half of 2021. The duration of the stay of patients with cataracts in a round-the-clock hospital decreased, amounting to 3 days. The waiting times for surgical treatment of cataracts have remained practically unchanged. Conclusion. Despite significant changes in the work of the clinic during the COVID-19 pandemic, the level of surgical treatment for cataracts has decreased slightly. Thanks to the measures taken to reconfigure the processes, it was possible to keep the work of the institution at an acceptable level. Key words: cataract surgery, COVID-19 pandemic.

Changing Trends in Corneal Transplantation in Aotearoa/New Zealand, 1991 to 2020: Effects of Population Growth, Cataract Surgery, Endothelial Keratoplasty, and Corneal Cross-Linking for Keratoconus.

The purpose of this study was to identify trends in the primary indication for keratoplasty in New Zealand/Aotearoa (NZ) after significant population growth, increase in the number of cataract surgeries per population, widespread adoption of endothelial keratoplasty, and introduction of corneal cross-linking for keratoconus. Statistical analysis of the New Zealand National Eye Bank's prospective database of all keratoplasties was performed between January 1991 and January 2020. Indications for keratoplasty were isolated for the primary diagnosis. In total, 6840 corneas were transplanted with mean 236 ± 57.5 transplants/year, increasing from 2.55 to 6.06 per 100,000 NZ population/year. Over the past decade, the number of transplant recipients aged 60 years or older has increased and recipients aged 20 to 39 years have plateaued. In 2019, for the first time, regraft became the most common indication (30.9%), followed by keratoconus (27.9%) and corneal dystrophy (18.8%), with a steady decline in bullous keratopathy. Proportions of the keratoplasty technique changed dramatically: penetrating keratoplasty fell from 91.4% in 2006 to 55.0% in 2019, Descemet's stripping endothelial keratoplasty increased from 0% to 29.5%, anterior lamellar keratoplasty increased from 2.5% to 5.7%, and Descemet membrane endothelial keratoplasty increased from 0% to 9.1%. Keratoplasty trends in Aotearoa/NZ have changed considerably because of the evolution of phacoemulsification and keratoplasty techniques. Unlike proportions observed overseas, NZ still performs penetrating keratoplasties in over half of all transplants. Corneal cross-linking may be having an early effect of reducing keratoplasty rates for keratoconus.

Influence of pupil dilation on the Barrett universal II (new generation), Haigis (4th generation), and SRK/T (3rd generation) intraocular lens calculation formulas: a retrospective study

BackgroundDespite the surge in the number of cataract surgeries, there is limited information available regarding the influence of pupil dilation on predicted postoperative refraction and its comparison with recommended various intraocular lens power calculated using the different parameters. We used three different IOL power calculation formulas: Barrett Universal II (Barrett) (5-variable formula), Haigis (3-variable formula), and SRK/T (2-variable formula), in order to investigate the potential effect of pupil dilation on the predicted postoperative refraction (PPR) and recommended intraocular lens (IOL) power calculation.MethodsThis retrospective study included 150 eyes. All variables were measured and calculated using a ZEISS IOL Master 700. The following variables were measured before and after dilation: anterior chamber depth (ACD), lens thickness (LT), white-to-white (WTW). PPR and recommended IOL power were calculated by Barrett, Haigis, and SRK/T IOL calculation formulas. The change in each variable before and after dilation, and the correlations between all changes were analyzed using the Wilcoxon signed-rank test and the Spearman’s rank-order correlation test, respectively.ResultsThe mean absolute change (MAC) in PPR before and after dilation was found to be highest in the Barrett formula. Significant differences were found between each MAC (P < 0.0001). Significant changes were observed before and after dilation in ACD and LT (P < 0.0001), but not in WTW. Using the Barrett and Haigis formulas, there was a significant positive correlation between the change in PPR and change in ACD (P < 0.0001), and a negative correlation between change in PPR and change in LT (P < 0.0001). The correlations were strongest with the Barret formula followed by the Haigis, particularly in terms of LT. Changes in PPR determined by the Barrett formula also demonstrated a significant positive correlation with changes in WTW (P = 0.022). The recommended IOL power determined using Barrett and Haigis changed before and after dilation in 23.3 and 19.3% cases respectively, while SRK/T showed no change.ConclusionsIn terms of PPR and recommended IOL power, pupil dilation influenced mostly the Barrett formula. Given the stronger correlation between the changes in PPR when using Barrett and the changes in ACD, LT, and WTW, changes in ACD, LT, and WTW significantly affect how dilation influences the Barrett formula. Determining how dilation influences each formula and other variables is key to improving the accuracy of IOL calculations.

Analysis of the Change in the Number of Cataract Surgeries: KNHIS Data 2013-2018

ëª©ì  2012ë „ 7월 이후 í¬ê´„ìˆ˜ê°€ì œ ë„ìž ê³¼ 2014ë „ë¶€í„° ì„ íƒì§„ë£Œë¹„ì˜ ë‹¨ê³„ì  폐지라는 ì œë„ì  변화가 있었다. 이에 따라 2013ë „ë¶€í„° 2018ë „ê¹Œì§€ ë°±ë‚´ìž¥ìˆ˜ìˆ ê±´ìˆ˜ì— ì–´ë– í•œ 변화가 있었는지 알아보았다. 대상과 방법 국민건강보험공단에서 ì œê³µí•˜ëŠ” 주요 ìˆ˜ìˆ í†µê³„ 연보 자료를 사용하였다. 2013ë „ë¶€í„° 2018ë „ê¹Œì§€ ì „êµ­ ë°±ë‚´ìž¥ìˆ˜ìˆ ê±´ìˆ˜ë¥¼ 연도별로 íŒŒì• í•˜ê³ , 이를 다시 성별, ì—°ë ¹ë³„, 지역별, ê·¸ë¦¬ê³ ì˜ë£Œê¸°ê´€ ì¢ ë³„ë¡œ 나눈 후, 각각의 ë°±ë‚´ìž¥ìˆ˜ìˆ ê±´ìˆ˜ì— 어떤 변화가 나타났는지 알아보았다. 통계는 Joint point regression 방법을 이용하였다. ê²°ê³¼ 인구 10만 ëª ë‹¹ ë°±ë‚´ìž¥ìˆ˜ìˆ ê±´ìˆ˜ëŠ” 6ë „ê°„ 총 32.9% ì¦ê°€í•˜ì˜€ê³ , 해마다 ì—°í‰ê· 5.9% 증가율을 보였다. 성별에 따른 ìˆ˜ìˆ ê±´ìˆ˜ëŠ” 지난 6ë „ê°„ 여성(58.0-59.2%)이 남성(40.8-42.0%)에 비해 높았다. 40대 이하, 40대, 50대, 60대 ì—°ë ¹êµ°ì—ì„œëŠ” 10만 ëª ë‹¹ ìˆ˜ìˆ ê±´ìˆ˜ê°€ 증가 추세를 보였다. 지역별 구성 비율은 서울, 부산, 대구와 같은 대도시는 증가한 반면, ì œì£¼ë„ë¥¼ ì œì™¸í•œ 대부분의 도 단위에서는 감소하는 경향을 보였다. 환자의 거주지를 기준으로 타지역에서 받는 ìˆ˜ìˆ ê±´ìˆ˜ì˜ 비율은 서울, 부산, 대구와 같은 대도시에서 증가 추세를 보였다. 의료기관 ì¢ ë³„ì— 따른 ìˆ˜ìˆ ê±´ìˆ˜ 구성 비율에는 차이가 없었다. ê²°ë¡ ë‹¨ìœ„ 인구 10만 ëª ë‹¹ ë°±ë‚´ìž¥ìˆ˜ìˆ ê±´ìˆ˜ëŠ” 증가하는 추세를 보였다. 지역별로는 대도시 ì ë¦¼ 현상은 관찰되었으나, ì „êµ­ 단위의 ìƒê¸‰ì¢ í•©ë³‘ì›ìœ¼ë¡œì˜ ì ë¦¼ 현상은 나타나지 않았다. Keywords: Cataract surgery, Diagnosis-related group, Institutional changes, Selective-medical expense

Cataract blindness in Hungary.

To estimate the prevalence of blindness and visual impairment resulting from cataract in the population aged ≥50y in Hungary, and to assess the cataract surgical services. A rapid assessment of avoidable blindness (RAAB) was conducted. A total of 3523 eligible people were randomly selected and examined. Each participant underwent surgery for cataract was interviewed with regard to the year, place, and costs of the surgery. Participants with obvious cataract were asked why they had not yet undergone surgery (barriers to surgery). An estimated 12 514 people were bilaterally blind; the visual acuity (VA) in 19 293 people was <6/60, and the VA in 73 962 people was <6/18 in the better eye due to cataract. An estimated 77 933 eyes are blind; 98 067 eyes had a VA of <6/60, and an estimated 277 493 eyes had a VA of <6/18 due to cataract. Almost all cataract surgeries were conducted in government hospitals. The age- and sex-adjusted cataract surgical coverage with VA<3/60 in eyes was 90.0%. The rate of good visual outcome after surgery was 79.5%. Ocular comorbidity was the main cause of poor outcome (78.1%), followed by late complications (such as posterior capsule opacification) (17.2%), inadequate optical correction (3.1%), and surgical complications (1.6%). The main barrier to surgery in people with bilateral cataract and VA of <6/60 was 'need not felt'. The prevalence of visual impairment resulting from cataract is slightly higher than expected. The quality of the cataract surgical service seems adequate in Hungary. However, the number of cataract operations per year should continue to increase due to the increasing patient demands and the aging population.

Incidence, Prophylaxis and Visual Outcomes of Acute Postoperative Endophthalmitis after Cataract Surgery: A Multicenter Retrospective Analysis in Northern China

Background: Cataract is the most prevalent cause of blindness worldwide, and millions of cataract surgeries are performed in China every year. Postoperative endophthalmitis (POE), a devastating infectious complication of cataract surgery, often results in extremely poor visual prognosis, even blindness. We investigated the incidence of acute POE after cataract surgery in Northern China from 2012 to 2018, evaluated the effectiveness of perioperative infection prophylaxis and analyzed the potential prognosis factor for the final visual outcome of POE patients. Methods: The study was designed as a retrospective multicenter research, with seven hospitals in Northern China enrolled. The diagnosis of acute-onset POE was mainly made on the basis of clinical manifestations within six weeks after initial surgery. By reviewing electronic medical system, the number of cataract surgeries and acute POE cases were recorded to estimate the overall incidence and incidences among different years and hospitals. Perioperative measures for preventing infection in different hospitals were collected to evaluate their effectiveness in reducing the risk of developing POE. The correlations between final visual acuity and potential factors including basal information and clinical characteristics were examined to determine the predictive factors for the visual prognosis. Findings: Of 72,255 cataract surgeries performed during seven years in the seven hospitals, 19 cases developed acute POE, yielding an incidence of 0·026% (95%CI 0·015%, 0·038%). The occurrence rate of acute POE significantly declined year by year over the period (p=0·021), from 0·056% in 2012 to 0·007% in 2018. The incidence of acute POE significantly decreased in Hospital-D after the application of 0·5% povidone-iodine (PVP-I) for conjunctival washing (p =0·003). Two hospitals adopting tobramycin in the irrigation solution achieved a significant lower incidence than the other hospitals (p=0·044). At the onset of endophthalmitis, the best BCVA presented was 20/70 and only four patients (21·1%) achieved BCVA better than counting fingers (CF). The positive rate of pathogen culture was just 17·6% (3/19) in our study, with Staphylococcus hominis isolated in two cases and Streptococcus cultured in one case. Patients with presenting BCVA of CF or better was more likely to achieve a better final visual outcome than those with worse presenting BCVA (p=0·003). Interpretation: In the past seven years, the incidence of POE after cataract surgery declined annually in Northern China, but there are still broad gaps among different level hospitals which much more effort should be made to eliminate. Due to the regional variation in the POE incidence, it is essential for cataract surgeons to figure out the recent incidence and changing tendency of POE in their own regions, thereby being sensitive and keeping alerting to its occurrence. Prophylactic use of 0·5% PVP-I and tobramycin in irrigation solution should be applied to prevent POE after cataract surgery, and presenting BCVA could be regarded as a prognosis factor for the final visual outcome. Funding Statement: National Science and Technology Major Project (2018ZX10101004) Declaration of Interests: The authors declare no competing interests. Ethics Approval Statement: The study was designed as a retrospective multicenter research. It was approved by the Ethical Committees of all the included hospitals and conformed to the tenets of the Declaration of Helsinki.

A comparative study of post-operative endophthalmitis between immediate versus delayed management of eventful cataract extraction.

Objective:To compare the incidence of postoperative endophthalmitis after eventful cataract surgery i.e. posterior capsular rupture, in patients managed with anterior vitrectomy and intra ocular lens implantation intraoperatively to patients managed with anterior vitrectomy and intraocular lens implantation two weeks after the posterior capsule rupture.Methods:This comparative study was conducted at Layton Rahamatullah Benevolent Trust, Free Base Eye Hospital Korangi, Karachi from February 2017 to December 2018. The study included two groups, group A had patients with intra ocular lens implanted after posterior capsule rupture intraoperatively, while Group B had patients with intra ocular lens implanted after two weeks of initial surgery. Incidence rate of post-operative endophthalmitis was compared between two groups, which happened within six weeks after intra ocular lens implantation surgery.Results:Total number of cataract surgeries that were performed during the study was 37,969. Incidence of postoperative endophthalmitis was 0.0019%. The study enrolled patients with complicated cataract surgeries that were 3508 (0.09%). Out of which incidence of post-operative endophthalmitis that occurred in group A was 0.007% and group B was 0.002%. (p value <0.05). The study also found that complicated extracapsular cataract extraction with intraocular lens implantation had more cases of endophthalmitis compared to phacoemulsification with intraocular lens.Conclusion:This study showed that management of posterior capsular rupture through anterior vitrectomy and secondary intraocular lens implantation after two weeks has less chances of postoperative endophthalmitis.