Effective cataract surgical coverage in India: Evidence from 31 districts.

BACKGROUND: Effective Cataract Surgical Coverage (eCSC) is a core outcomes domain indicator to assess accessibility and quality of eye care services with limited available information. PURPOSE: To generate baseline estimates of eCSC for India. METHODS: We performed the analysis of data pooled from Rapid Assessment of Avoidable Blindness surveys conducted in 31 districts of India during 2015-2019 among persons aged 50+ years. eCSC was calculated at various thresholds, the primary being operable cataract at best corrected visual acuity <6/12, good outcome at presenting visual acuity of 6/12. RESULTS: Age-sex standardized and weighed eCSC in India was 36.7% (95% CI: 33.6, 39.9), and cataract surgical coverage (CSC) was 57.3% (95% CI: 53.3, 61.2), a relative quality gap in cataract surgery being 36.0%. eCSC in males was higher at 38.0% than females (35.6%). eCSC increased with education from 31.0% in illiterate participants to 59.7% in class 10 educated. On multivariate analysis, rural setting, increasing age, and residence in eastern or northeastern zones of India continued to be associated with poor/worse eCSC, while female gender was associated with higher eCSC. District-wide variations in eCSC were observed. CONCLUSION: Developmental factors have an important bearing on eCSC in India. Geographical variations point toward the need for targeted, locally relevant strategies.

BKC and CME: Is benzalkonium chloride hindering our efforts to achieve the desired postoperative visual acuity?

PURPOSE: To evaluate and compare the change in postoperative central macular thickness in patients receiving benzalkonium chloride (BKC)-preserved and BKC-free medications after uneventful phacoemulsification. SETTING: V.M.M.C & Safdarjung Hospital, New Delhi (a tertiary health care hospital). STUDY DESIGN: Prospective randomized comparative observational study. MATERIALS AND METHODS: Once patients were selected, the baseline standard ophthalmic examination was done. SAMPLE SIZE: 140 eyes were enrolled and randomly divided into two groups. (a) Group I: receive BKC-preserved topical medications and (b) Group II: receive BKC-free topical medications of same constituents postoperatively. Group I patients received topical BKC-preserved moxifloxacin 0.5% + dexamethasone 0.1% eye drops six times a day, timolol maleate 0.5% twice daily, tropicamide 0.8% + phenylephrine 5% once a day for 6 weeks, and Group II received same BKC-free topical eye drops for 6 weeks. Postoperatively, the patients were reviewed at day 1, week 1, week 6 for same parameters. STATISTICS: Quantitative variables: paired and unpaired t test. p value < 0.05 was considered statistically significant. RESULTS: The mean CMT in µm at 1 week in Group I was 269.39 ± 14.56 and in Group II was 270.04 ± 6.56. The mean CMT in µm at 6 weeks in Group I was 270.39 ± 17.18 and in Group II was 270.90 ± 7.00. CONCLUSION: Neither do BKC-preserved topical medications have any independent role in increasing the central macular thickness after uneventful surgery nor do they have any role in causing pseudophakic CME.

Idiopathic Bilateral Suprachoroidal Haemorrhage: A Rare Case Presentation.

55-year-old male presented with sudden onset painful diminution of vision in both eyes. On local examination, his visual acuity was FC at 2 metres in right eye and FC at 1 m in left eye. The IOP in right eye was 46 mm Hg and 44 mm Hg in left eye. The patient was admitted and started on injection mannitol, oral syrup glycerol, and oral acetazolamide. Locally, timolol maleate and brimonidine were also started. The next day, his IOP was 17 mm Hg bilaterally but his visual acuity deteriorated to FC 1 m in right eye and hand movement in left eye with inaccurate projection of rays in both eyes. USG B-scan was performed which revealed bilateral choroidal detachment. The echotexture of fluid was suggestive of haemorrhage. As the IOP was controlled, systemic hyperosmotic/antiglaucoma agents were withdrawn in stepwise fashion over next two days. The patient was started on oral prednisolone. At 2 weeks, the visual acuity in both eyes was only perception of light, with inaccurate PR. IOP was 10 mm Hg in both eyes. USG B-scan revealed resorption of the hemorrhage, with partial resolution of the choroidal detachment. The final BCVA was 6/18 and 6/12 in right and left eye.