"Show me the way" - Endoilluminator-assisted manual small-incision cataract surgery in a case of corneal scar with a small pupil.

Cataracts with coexisting corneal opacities due to various causes present a daunting challenge to surgeons. Adding to the plight could be factors like shallow anterior chamber, small pupil and mono-ocular patient. A manual small-incision cataract surgery (MSICS) could be a saviour in such situations. We demonstrate a case of post perforation corneal scar secondary to Hansen's disease with complicated cataract with non-dilating pupil in a bilaterally blind patient. Due to poor visualisation, there could have been difficulties in capsulorrhexsis, cortex aspiration & many other intraoperative manoeuvres, but use of an endo illuminator providing oblique illumination was very useful, resulting in uneventful surgery with good visual outcome. MSCICS, a surgery with minimal instrumentation, short learning curve and comparable results to phacoemulsification is perhaps the preferred procedure, in India, for complicated cataracts with multiple pre-existing pathologies.

Cataract surgery at Marie Adelaide Leprosy Centre Karachi: an audit.

OBJECTIVE: To determine the outcome of cataract surgery in terms of visual results, intra and postoperative complications at Marie Adelaide Leprosy Centre. METHODS: The study was carried out at Marie Adelaide Leprosy Centre Karachi from May 2005 to December 2007. Surgical results of all outpatients operated for cataract from May 2005 to December 2007 were assessed. The data was collected using the CBM guidelines based on WHO monitoring systems for quality monitoring. Patients having uncomplicated cataract were included. Postoperative follow up was done at discharge, 1 week, 4 weeks and after 12 weeks, visual acuity was recorded as good (6/6-6/18), borderline (6/18-6/60) and poor (< 6/60), intraoperative and postoperative complications were also noted. RESULTS: During the study period a total of 1457 patients underwent cataract surgery. There were 826 male patients and 631 female patients, their age ranged from 20 to over 80 years. Preoperatively 1023 (70.2%) patients had poor, 362 (24.8%) patients had borderline while only 73 (5%) patients had good visual acuity while at discharge 962 (66%) patients had good, 392 (26.9%) patients had borderline and 104 (7.1%) patients had poor visual acuity. On an average among all the best corrected visual acuity was good in 97.2%, borderline in 2.2% and poor in 0.6% patients at 1 week, 4 weeks and >12 weeks follow up respectively. A large number of patients, 565 (38.7%) did not turn up after discharge for follow up, presumed reasons were: good vision, unable to return because of socioeconomic reasons, ill health and few of the patients expired. Intraoperative complications seen were posterior capsular rent with vitreous loss 70 (4.8%), zonular dehiscence 3 (0.2%), posterior loss of cortical matter 2 (0.1%) and iris prolapse in 4 (0.2%) cases. Immediate postoperative complication was striate keratopathy 157(10.7%), late were chronic anterior uveitis 3 (0.2%), corneal decompensation 2 (0.1%) choroidal and retinal detachment 1 (0.06%) each, Intraocular Lens (IOL) subluxation 4 (0.2%) and Posterior capsular opacification 40 (2.7%). CONCLUSION: In our study visual outcome achieved was comparable to the standards set by World Health Organization. In complicated cases functional vision can be achieved with timely management.

Prevalence and causes of blindness and low vision in leprosy villages of north eastern Nigeria.

AIMS: To determine the prevalence and spectrum of ocular pathology, and the prevalence and causes of blindness and low vision in leprosy villages of north eastern Nigeria. METHODS: People affected by leprosy, aged 30 years and above, resident in eight leprosy villages were invited to participate. Ocular examination was undertaken of each consenting individual. RESULTS: 480 people were examined. 456 (48%) of 960 eyes had at least one ocular lesion, but only 37% of all lesions were leprosy related and potentially sight threatening. The prevalence of blindness (VA<3/60 with available correction) was 10.4%. An additional 7.5% of subjects were severely visually impaired (3/60< or =VA<6/60). Cataract was the commonest cause of blindness. Other major causes were non-trachomatous corneal opacity and trachoma. CONCLUSIONS: Blindness and low vision are highly prevalent among leprosy patients in this setting. Only a third of the burden of ocular pathology is related to the direct effects of leprosy. Efforts to reduce the backlog of cataract and trichiasis, to improve early detection and management of lagophthalmos, and to provide refractive services are urgently required.

Knowledge and management of disabling conditions in South Asian histories: implications for leprosy futures.

Elimination of leprosy as a public health problem appears feasible in South Asia in the present decade through multi-drug therapy, but management of disability in cured leprosy patients will continue through the 21st century, probably with some ongoing stigma. This paper provides new perspectives on leprosy-related disabilities by reviewing the historical careers of four disabling conditions sharing some features with leprosy: lathyrism, iodine deficiency disorders (IDD), cataract and poliomyelitis. All are targeted for eradication or serious reduction using affordable surgery or preventive measures, yet they have proved unexpectedly resilient. Technical solutions alone bring only partial success. There is a need also for community-based delivery methods, individual and family self-help, and some redeployment of professional expertise.

Intraocular lens implantation in leprosy.

The preoperative, operative and postoperative ocular complications in 48 eyes of 39 leprosy patients who underwent standard extracapsular cataract extraction and posterior chamber intraocular lens implantation, by the same surgeon, were studied retrospectively. Seventeen were male and 22 were female. Thirteen (33%) were paucibacillary (PB) while 26 (67%) were multibacillary (MB) patients. Three patients were smear-positive at the time of surgery. Grade 2 deformity that included claw hands, absorbed fingers, saddle noses and foot drop were present in 64% of the patients. None of the patients had any previous intraocular inflammation although one patient had previously had a Type 1 reaction and 5 patients had previously had Type 2 reactions. Preoperative complications like corneal opacities (3 eyes) and lagophthalmos (5 eyes) were not associated with lower vision postoperatively. No significant operative complications like vitreous loss, endothelial damage or iris tear were encountered, except in one eye where there was a posterior capsular tear. Seventeen eyes (35%) developed uveitis of 3+ or more in the immediate postoperative period, but abated with routine topical steroid eye drops. Six months after surgery 7 out of 47 eyes (15%) had developed posterior capsular opacities. There were no significant differences (p = > 0.05) in the visual acuity outcomes or in ocular complications when MB patients were compared with PB patients. Smear-positive patients were not significantly different from smear-negative patients when postoperative complications were compared. Visual outcomes in the 23 eyes followed up at two years after surgery were 6/18 or higher, except in one eye which had sustained a severe injury one year after surgery. IOLs were found to be safe and beneficial in this series of patients, but a much larger prospective study with matched normal controls is needed to prove the safety and efficacy of IOLs in leprosy patients.

Leading causes of blindness worldwide.

The main causes of blindness and visual disabilities, as described in documents published by the World Health Organization (WHO), are discussed.

Blindness in Africa: present situation and future needs.

AIM: To review the prevalence and causes of blindness in sub-Saharan Africa, the existing services and limitations, and the Vision 2020 goals for the future. METHODS: Methodologically sound population based surveys published in the past 20 years are reviewed and results for prevalence and causes of blindness are tabulated. The current resources and needs according to recent publications and international working groups are described. CONCLUSIONS: Blindness prevalence rates vary widely but the evidence suggests that approximately 1% of Africans are blind. The major cause is cataract; trachoma and glaucoma are also important causes of blindness. The bulk of blindness in the region is preventable or curable. Efforts should focus on eye problems which are universally present and for which there are cost effective remedies, such as cataract and refractive problems and on those problems which occur focally and can be prevented by primary healthcare measures, such as trachoma, onchocerciasis, and vitamin A deficiency. Major development of staffing levels, infrastructure, and community programmes will be necessary to achieve Vision 2020 goals.

Cataract in leprosy patients: cataract surgical coverage, barriers to acceptance of surgery, and outcome of surgery in a population based survey in Korea.

BACKGROUND/AIMS: Cataract is the leading cause of blindness in leprosy patients. There is no population based information on the cataract surgical coverage, barriers to use of surgical services, and outcome of surgery in these patients. We sought to determine these measures of cataract programme effectiveness in a cured leprosy population in South Korea. METHODS: The population consisted of residents of six leprosy resettlement villages in central South Korea. All residents were invited to participate in a study of eye disease and interviewed regarding use of surgical services and reasons for not using these services. RESULTS: The cataract surgical coverage in this population was 55.4% when <6/18 was used as the cut off and increased to 78.3% when the cut off was <6/60. Barriers reported by patients included being told by the doctor that the cataract was not mature and a perception by the patient that there was no need for surgery. Among patients who had aphakic surgery, 71% were still blind in the operative eye while among patients who had pseudophakic surgery, 14% were still blind (presenting vision). Blindness in pseudophakic patients could be reduced to 3% with spectacle correction. CONCLUSION: Cataract prevalence in leprosy patients will increase as life expectancy continues to increase. Leprosy control programmes will need to develop activities aimed at reducing the burden of cataract. Recommendations include establishing collaborative agreements with ophthalmological services to provide high quality IOL surgery to these patients, training of health staff to identify and refer patients in need of surgery, monitoring the uptake of cataract surgery among patients needing services, and monitoring the outcome of surgery to improve refractive outcome.

[Phacoemulsification-aspiration technique with intraocular lens implantation in leprosy patients].

The author analyzed the results of cataract surgery performed in 25 eyes of 22 leprosy patients. All the eyes were treated by phacoemulsification-aspiration technique with intraocular lens implantation. The subjects consisted of 15 eyes of 14 leprosy patients with past history of uveitis and 10 eyes of 8 leprosy patients without uveitis. The mean follow-up time after surgery was 20 months and 23 months, respectively. In 93% of eyes with uveitis and 90% of eyes without uveitis, the postoperative vision improved by 2 lines or more. Postoperative complications were higher among patients with uveitis (93%) compared with patients without uveitis (40%). But no serious complications were encountered in patients with uveitis.

Salud ocular comunitaria: en busqueda de soluciones; primera parte / Ocular community health: in search of solutions; first part

Enfermedades como la catarata, tracoma, glaucoma, oncocercosis, xeroftalmia, degeneracion macular, retinopatia diabetica y lepra son las principales causas de ceguera en el mundo. El 93% de los ciegos estan distribuidos en Asia, Africa y Latinoamerica como resultante de las desfavorables condiciones socio-economicas, ambientales, culturales y el limitado acceso da la atencion oftalmologica de sus habitantes. De acuerdo con las estadisticas presentadas en Colombia es prioridad desarrollar un programa nacional de salud ocular, que ademas de realizar acciones para la prevencion de la ceguera, incluya la atencion adecuada de otros problemas visuales como los defectos refractivos y de patologias oculares que, a pesar de no ser causa de limitacion visual permanente, necesitan tratamiento medico o quirurgico. A nivel departamental, la Fundacion Oftalmologica de Santander -FOS, con el apoyo de organismos internacionales, avanza en la planeacion de actividades de investigacion basica y en el desarrollo de programas de prevencion y tratamiento para las poblaciones mas necesitadas

Cataract surgery on leprosy patients.

All patients who had cataract surgery at the Schieffelin Leprosy Research and Training Centre, Karigiri, India, between January 1979 and April 1985 were studied to find out the outcome of that surgery. These patients included 291 leprosy cases and 89 nonleprosy cases. Postoperative complications were slightly higher among leprosy patients compared to the nonleprosy cases. Visual recovery was marred by preoperative corneal opacities in some of the leprosy patients. Eyes with chronic insidious type of iridocyclitis did not produce any devastating results postoperatively. Patients whose skin smears were still positive for leprosy bacilli did not show any major complication. All leprosy patients should be offered the benefit of cataract surgery for restoring sight because blindness in leprosy would mean a double handicap if they are already suffering from insensitive, deformed hands and feet.

[Eye diseases and ophthalmological care in a developing country (author's transl)]. / Augenkrankheiten und ophthalmologische Versorgung in einem Entwicklungsland. Bericht über ein Eye-Camp in Andhra Pradesh/Indien.

Five million blind people in India suffer from cataract, which is a curable condition. Untreated cataract accounts for more than half of the cases of blindness in that country. Twenty percent of all cases of blindness are caused by infections, while malnutrition accounts for 27% in children. In India, ophthalmological care has been provided for many years now in eye-camps. In cataract surgery, the expression method is customary. Trachomas at all stages, infectious eye diseases, traumatic lesions, vitamin A deficiency and leprosy are also diagnosed and treated in large numbers of cases. By way of an example the authors, assistants at the First Eye Clinic of Vienna University, describe an eye-camp in Andhra Pradesh where they worked. Work of this kind can be recommended to others.