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Comparison of discharge and one month follow-upsubjective and objective refraction following biometry-ledsutureless extra-capsular cataract extraction in a ruralAfrican population

  • Aim: To evaluate the short and medium term visual and refractive outcomes of a cohort of patients undergoing biometry-led sutureless extracapsular cataract extraction (ECCE) with implantation of posterior chamber intraocular lenses (PCIOL) in a rural African population. Methods: Cataract surgery was carried out on 96 eyes with PCIOL implantation according to biometry findings. After surgery, unaided visual acuity was assessed and objective and subjective refraction was assessed at discharge and again between 4 to 8 weeks follow-up in order to obtain the best-corrected visual acuity and report on surgically induced astigmatism. Results: 96 eyes of 68 patients were examined. 55 patients were excluded from the study because of lack of cooperation, the implantation of anterior chamber intraocular lenses or for other reasons (63.6% participation rate). The preoperative visual acuity was less than 3/60 in 43.8% of eyes, between 3/60 and 6/60 in 52.1% of eyes and 6/36 in 4.2% of eyes. The discharge refraction was taken 1 to 8 days and follow-up refraction was recorded 4 to 8 weeks after surgery. The unaided visual acuity at discharge was &#8805;6/18 in 45.3% of eyes and in 60.6% of eyes at follow-up. It was between 6/24 and 6/60 in 54.7% of eyes at discharge and 36.2% at follow-up. Unaided visual acuity <6/60 occurred in 3.2% of eyes at follow-up, whereas no poor outcomes (VA <6/60) were recorded at discharge. Best-corrected visual acuity of &#8805;6/18 was achieved in 78.5% of eyes at discharge and in 88.5% of eyes at followup. It was between 6/24 and 6/60 in 21.5% of eyes at discharge and in 9.6% of eyes at follow-up. Best-corrected visual acuity <6/60 only occurred in 2.1% of eyes at follow-up. The predicted post-operative spherical equivalents ranged from -0.76D to +0.29D (mean value: - 0.27D; SD: 0.19). The spherical equivalents found in refraction at discharge ranged from -3.25D to +2.88D (mean value: -0.88D; SD: 1.08) and at follow-ups from -2.50D to +2.25D (mean value: -0.58D; SD: 0.95). At discharge 3.2% of eyes were emmetropic, 79.8% were myopic and 17.0% were hyperopic. At follow-up 13.7% of eyes were emmetropic, 65.3% were myopic and 21.1% were hyperopic. Astigmatism was found in 70 eyes (74.5%) at discharge and in 57 eyes (60.0%) at follow-up. Conclusion: Sutureless ECCE with biometry-led selection of IOL is an effective and appropriate intervention for cataract blindness and visual impairment in rural Africa. Postoperative vision improves significantly at 1-2 month follow-up when compared to immediately post-op, although the small proportion of poor outcomes appears to increase in the same time period. Further research is needed to ascertain the longer term results of surgery, to focus on vision and induced astigmatism. It is also important to assess the patient’s subjective satisfaction with vision following sight restoring surgery.

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Metadaten
Author:Katrin Harms
URN:urn:nbn:de:bsz:944-opus-121
Document Type:Bachelor Thesis
Language:English
Date of Publication (online):2012/01/25
Publishing Institution:Hochschule Aalen
Release Date:2012/01/25
GND Keyword:Augenoptik
Faculty:Optik und Mechatronik / Augenoptik und Hörakustik
DDC classes:600 Technik, Medizin, angewandte Wissenschaften / 610 Medizin, Gesundheit
Open Access:Closed Access
Licence (German):License LogoVeröffentlichungsvertrag für Publikationen mit Print on Demand