The effect of multimedia interventions on the informed consent process for cataract surgery in rural South India.

CONTEXT: The provision of ocular surgical interventions for poorer, less educated populations is increasing as a result of increased globalization and outreach. However, these populations still have trouble understanding surgical concepts and are not always fully informed decision makers. AIMS: We aimed to test the effect that a multimedia addition to a traditional verbal informed consent would have on patient comprehension of relatively difficult cataract surgical concepts. SETTINGS AND DESIGN: We conducted a randomized controlled trial with relatively uneducated patients reporting to a private surgical hospital in Chennai, India. 47 patients were placed into the intervention group and 50 patients were placed into the control group. MATERIALS AND METHODS: The intervention group was presented with a scripted verbal informed consent as well as a 3-fold pamphlet and a presentation with a 3-dimensional model of the eye. The control group was only presented with a scripted verbal informed consent. The two groups were tested using an 11 item "True/False/I don't know" quiz directly before the informed consent, directly after the informed consent, and one-day postoperatively. STATISTICAL ANALYSIS USED: Scores on the quiz were compared across groups and time-points using paired t-tests. RESULTS: Patients in the both groups showed a significant improvement in scores between pre- and post-informed consent quizzes (P value on the order of 10(-6)) and the improvement in scores was significantly greater in the intervention group than the control group (P value on the order of 10(-16)). There was no significant difference observed in either group with regards to the change in scores between post-informed consent and post-operative quizzes. CONCLUSION: Multimedia aids in addition to a standard informed consent process are effective in improving patient comprehension even for patients with low literacy and limited knowledge of surgical interventions.

5-Fluorouracil for epithelial downgrowth after Descemet stripping automated endothelial keratoplasty.

PURPOSE: To report the use of intracameral 5-fluorouracil (5-FU) to treat epithelial downgrowth after performing a Descemet-stripping automated endothelial keratoplasty (DSAEK). METHODS: We describe the case of a 79-year-old woman who underwent a DSAEK for pseudophakic Fuchs endothelial corneal dystrophy. The patient required 2 repeat DSAEKs for graft failure and persistent, visually significant interface haze. Six months after the third and most recent DSAEK, the patient was followed up and found to have a visual acuity of 20/100. On examination, the patient continued to have a persistent interface haze. However, the patient also had a cellular anterior chamber reaction despite the administration of frequent topical corticosteroids, and subtle findings of a translucent, membranous growth over the iris. Argon laser photocoagulation of the area resulted in a whitening response, characteristic of epithelial growth. RESULTS: Epithelial downgrowth was diagnosed, and intracameral 5-FU was administered. One month after the injection was given, the patient's examination results and vision improved to 20/60. Six months after the single injection, the patient had a clear DSAEK graft without interface haze, a quiet chamber, and 20/30 visual acuity. CONCLUSIONS: Epithelial downgrowth that occurs after performing a DSAEK can be treated successfully using intracameral 5-FU.