Visual outcome following posterior capsule rupture during manual small incision cataract surgery.

BACKGROUND: The quality of cataract surgery can be measured by visual outcome, which is sometimes limited by intraoperative complications, most commonly posterior capsular rupture. AIMS: The aim of the study was to assess visual outcome at the last visit (≥8 weeks) following posterior capsule rupture (PCR) in patients who had manual small incision cataract surgery (MSICS) managed without access to an automated vitrector. METHODS: A review of medical records of all manual small incision cataract surgeries performed between January 2013 and December 2016 at the National Eye Centre, Kaduna, Nigeria was conducted. Descriptive statistics and logistic regression analysis were performed using STATA 14.0 to examine risk factors for the development of a poor visual outcome and to assess the impact of PCR on development of poor visual outcome. RESULTS: In total, 405 patients were operated on with MSICS (50.6% males). Mean age was 62.4 (SD 12.6) years. PCR was the most common complication (n = 19 (4.7%)). The proportion of good outcomes (≥6/18) rose from 12.4% non-PCR and 0.0% for those with PCR at day 1 postoperative review, to 71.5 and 26.3%, respectively, by final follow up (P = 0.001). Patients with PCR were 7.0 (P = 0.0001) times more likely to have borderline/poor visual outcome (<6/18) compared to those without PCR. Age >60 years increased the odds of borderline/poor by 1.4 times (P = 0.002). CONCLUSION: PCR significantly affects the visual outcome of cataract patients in settings with no facilities for automated vitrectomy. Minimizing complications will improve visual outcome of cataract patients and increase uptake of cataract surgical services.

What are the priorities for improving cataract surgical outcomes in Africa? Results of a Delphi exercise.

PURPOSE: The quality of cataract surgery delivered in sub-Saharan Africa (SSA) is a significant constraint to achieving the elimination of avoidable blindness. No published reports from routine SSA cataract services attain the WHO benchmarks for visual outcomes; poor outcomes (<6/60) often comprise 20% in published case series. This Delphi exercise aimed to identify and prioritise potential interventions for improving the quality of cataract surgery in SSA to guide research and eye health programme development. METHODS: An initial email open-question survey created a ranked list of priorities for improving quality of surgical services. A second-round face-to-face discussion facilitated at a Vision 2020 Research Mentorship Workshop in Tanzania created a refined list for repeated ranking. RESULTS: Seventeen factors were agreed that might form target interventions to promote quality of cataract services. Improved training of surgeons was the top-ranked item, followed by utilisation of biometry, surgical equipment availability, effective monitoring of outcomes of cataract surgery by the surgeon, and well-trained support staff for the cataract pathway (including nurses seeing post-operative cases). CONCLUSION: Improving the quality of cataract surgery in SSA is a clinical, programmatic and public health priority. In the absence of other evidence, the collective expert opinion of those involved in ophthalmic services regarding the ranking of factors to promote quality improvement, refined through this Delphi exercise, provides us with candidate intervention areas to be evaluated.

A glaucoma equity profile: correlating disease distribution with service provision and uptake in a population in Northern England, UK.

AIMS: Glaucoma is a significant health problem, with associated inequalities. Equity profiles are an established public health tool to examine the scale of health inequalities and to imbed action into the commissioning cycle. This is the first equity profile conducted in the United Kingdom for an ophthalmic condition. This methodology also provides a model for use in other localities and for other eye conditions. METHODS: Existing services were mapped and need identified. A wide variety of data sources were analysed. Mapping was undertaken using Mapinfo Professional Geographical Information Systems software. Statistical analysis was conducted using Microsoft Excel 2003. RESULTS: No single data source provided a fully informed perspective. A clear mismatch between areas of deprivation and location of optometry was observed. Secondary analysis of electronic patient records revealed a significant association between 'late presentation' and older age (mean age of late presenters=76.4 years, 95% CI=75.1-77.6 compared with earlier presenters, 72.4 years, 95% CI=71.7-73.1). Late presentation was also associated with living in an area of high deprivation (chi(2)=7.1, df, P<0.05). Ethnicity data was poorly recorded. Qualitative data provided invaluable insights. CONCLUSIONS: Increasing access to services involves collaboration with optometrists, ophthalmologists, public health, and commissioners. It is no longer acceptable to rely on private high street optometry to provide primary eye care services in areas of high need. Outreach services must be developed and evaluated in areas of relative deprivation if world class eye services are to be achieved.

Do recorded abstracts from scientific meetings concur with the research presented?

PURPOSE: Research abstracts for scientific meetings are usually submitted several months in advance of the meeting. Authors may therefore be tempted to submit an abstract on the basis of the research that is ongoing or not yet fully analysed. This study aims to determine the extent to which submitted abstracts, often disseminated in printed form or online, differ from the research ultimately presented. The risk taken by clinicians considering changes in practice on the basis of presented research who refer back to the printed abstract can be assessed. METHODS: All posters presented at the Royal College of Ophthalmologists Annual Congress 2007 were compared with abstracts in the 'Final Programme and Abstracts'. Discrepancies were recorded for authorship, title, methodology, number of cases, results and conclusions. RESULTS: A total of 171 posters were examined. The title changed in 21% (36/171) and authorship in 25%. The number of cases differed in 22% (number of cases in the poster ranging from less than one quarter to more than triple the number in the abstract). Differences between abstract and poster were found in the methodology of 4%, the results of 11% and conclusions of 5% of studies. CONCLUSIONS: Scientific meetings provide an opportunity for timely dissemination of new research presented directly to clinicians who may then consider change of practice in response. Caution is advised when referring back to printed records of abstracts, as substantial discrepancies are frequently seen between the published abstract and the final research presented, which, in a minority of cases, may even alter the conclusions of the research.

Determinants of cataract surgical opportunities and complication rates in UK higher specialist training.

PURPOSE: The volume of cataract surgery performed by trainee ophthalmologists in the UK, and the complication rates experienced by those trainees is unknown. As a result, no appropriate audit benchmark exists for trainees or their trainers. This study describes the surgical opportunities and rates of posterior capsule rupture (PCR) experienced by higher specialist trainees in one UK training region and explores influencing factors. METHODS: Number of cataract operations and episodes of PCR in each calendar month were recorded from surgical logbooks for all Specialist Registrars (SpRs) who had completed at least 6 months of training by January 2007. Dates and details of the posts in which the surgery was performed were also recorded. RESULTS: Data from 475 completed months were collected from 19 trainees including 4322 cataract operations and 99 episodes of PCR. Trainees performed a mean 9.1 operations per month. This varied significantly between different subspeciality posts; the fewest cataracts were on paediatric and oculo-plastic firms. District General Hospitals offered more surgery than Teaching Hospitals; mean 10.9 vs 8.5 cataracts per month (P=0.005). No difference in surgical opportunity was found between male and female trainees. An overall PCR rate of 2.3% (95% CI 2.25-2.33%) was found, which decreased significantly with increasing experience (P<0.01). CONCLUSION: SpRs in Yorkshire expect to complete around 500 cataract operations in their 4.5 years of training. A PCR rate of 2.3% was found for trainees with a mean of 25 months higher specialist training which compares favourably with published series of trainees from other countries.