Elsevier

Ophthalmology

Volume 106, Issue 10, 1 October 1999, Pages 1887-1892
Ophthalmology

Low-cost high-volume extracapsular cataract extraction with posterior chamber intraocular lens implantation in Nepal

https://doi.org/10.1016/S0161-6420(99)90397-4Get rights and content

Abstract

Objective

To improve current clinical practices and ways of thinking about the problem of curable Third-World blindness resulting from cataract.

Design

A two-site prospective, nonrandomized, comparative clinical trial.

Participants

Patients from 2 distinct surgical venues underwent cataract surgery following the same carefully outlined protocol: 62 consecutive cases from the Tilganga Eye Centre in Katmandu, Nepal, and 207 cases from a remote eye camp in rural Chaughada, Nepal.

Intervention

Extracapsular cataract extraction with posterior chamber intraocular lens (IOL) implantation surgery using a technique developed by Dr. Sanduk Ruit of the Tilganga Eye Centre in conjunction with the Medical Directorate of the Fred Hollows Foundation of Australia. Also presented is the teaching method used to help make local doctors proficient in this technique.

Main outcome measures

Visual acuity recorded at 2 months after surgery as well as surgical complications.

Results

Preoperative visual acuities for the 62 patients from the Tilganga Eye Centre ranged from 20/60 to light perception only (4 patients were untested). At 2 months after surgery, 87.1% had a best-corrected visual acuity of 20/60 or better. There were zero major surgical complications reported from the Tilganga group. Of the 207 patients at the Chaughada eye camp, preoperative visual acuities (recorded for 177 [85.5%]) ranged from 20/200 or greater to light perception only. One hundred eighty-nine (91.3%) of the patients returned for an examination at 2 months after surgery, at which time 54.5% had an uncorrected visual acuity of 20/60 or greater, improving to 74.1% with correction. There were six (2.9%) surgical complications documented at Chaughada.

Conclusions

Because the average operative time using the technique presented here is less than 10 minutes per case and the cost per surgery is less than $20, the surgical results are significant in addressing the massive problem of cataract blindness in the Third World. With some changes in preoperative care, a simplified surgical technique, the development of local lens factories, and the implementation of teaching programs, effective lens implantation cataract surgery can be done in high volume at affordable costs in remote areas of underserved nations.

Section snippets

Materials and methods

The results of high-volume cataract surgery performed at both an eye hospital (Tilganga Eye Centre) and a remote eye camp setting (Chaughada) in Nepal are presented. All patients in both surgical venues received treatment following the same protocol and surgical technique. The technique was developed through the combined efforts of Dr. Sanduk Ruit of the Tilganga Eye Centre in conjunction with Dr. Fred Hollows and the Medical Directorate of the Fred Hollows Foundation of Australia. The

Results

The best preoperative visual acuities for the 62 consecutive patients from the Tilganga Eye Centre, with an average age of 63.4 years, were measured using both Snellen Letter Acuity and Illiterate E Charts. All of the patients returned for a follow-up at 2 months after surgery. Results from the Tilganga Eye Centre are listed in Table 1. There were no major surgical complications in this study group, but after surgery it was documented that there was one case each of macular scarring from

Discussion

The effectiveness of a simple technique for performing low-cost, high-volume cataract surgery in the developing world is shown. In addition to the 62 consecutive cases from this study, 6826 surgeries with IOL implantation have been performed at the Tilganga Eye Centre in the 2 years from January 1996 to December 1997 using the same method. Of this group, only two patients (0.029%) developed infectious endophthalmitis. The technique has also been used in 26 eye camps in Nepal and Tibet from 1992

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    Dr. Tabin has no financial interest in the Fred Hollows Foundation of Sydney, Australia, or the Fred Hollows Intraocular Lens Factory in Nepal. All travel to and from Nepal is done on a voluntary basis, with Dr. Tabin paying all of his own expenses. Dr. Ruit, Dr. Paudyal, and Dr. Gurung are full-time employees of the Tilganga Eye Centre. The Tilganga Eye Centre runs the Fred Hollows Intraocular Lens Laboratories in Nepal and has received support from the Fred Hollows Foundation. (The Fred Hollows Foundation is a community-based, nongovernment organization. The foundation was formally launched in Sydney in 1992 with the aim of raising funds to continue the work of Professor Fred Hollows and his quest to reduce the huge backlog of cataract blindness and provide equality of access to healthcare to the developing world.)

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