A comparative study of post-operative endophthalmitis between immediate versus delayed management of eventful cataract extraction.

OBJECTIVE: To compare the incidence of postoperative endophthalmitis after eventful cataract surgery i.e. posterior capsular rupture, in patients managed with anterior vitrectomy and intra ocular lens implantation intraoperatively to patients managed with anterior vitrectomy and intraocular lens implantation two weeks after the posterior capsule rupture. METHODS: This comparative study was conducted at Layton Rahamatullah Benevolent Trust, Free Base Eye Hospital Korangi, Karachi from February 2017 to December 2018. The study included two groups, group A had patients with intra ocular lens implanted after posterior capsule rupture intraoperatively, while Group B had patients with intra ocular lens implanted after two weeks of initial surgery. Incidence rate of post-operative endophthalmitis was compared between two groups, which happened within six weeks after intra ocular lens implantation surgery. RESULTS: Total number of cataract surgeries that were performed during the study was 37,969. Incidence of postoperative endophthalmitis was 0.0019%. The study enrolled patients with complicated cataract surgeries that were 3508 (0.09%). Out of which incidence of post-operative endophthalmitis that occurred in group A was 0.007% and group B was 0.002%. (p value <0.05). The study also found that complicated extracapsular cataract extraction with intraocular lens implantation had more cases of endophthalmitis compared to phacoemulsification with intraocular lens. CONCLUSION: This study showed that management of posterior capsular rupture through anterior vitrectomy and secondary intraocular lens implantation after two weeks has less chances of postoperative endophthalmitis.

RETROSPECTIVE INVESTIGATION OF CATARACT MANAGEMENT IN AVIAN SPECIES IN A ZOOLOGIC COLLECTION.

A review of avian cataracts at the Wildlife Conservation Society's Bronx Zoo between 1992 and 2011 was conducted. Ninety cataracts in 54 birds from 42 species were identified. Cataracts were found primarily during examination for ocular abnormalities (29/54, 53.7%) or opportunistically (13/54, 24.1%) and were most commonly diagnosed as mature (22/90, 24.4%). Systemic medical conditions diagnosed in these birds included West Nile virus (4/54, 7.4%), head trauma (3/54, 5.6%), plumbism and Salmonella Pullorum (1/54, 1.9%), Marek's disease (1/54, 1.9%), leukocytosis (1/54, 1.9%), and hyperglycemia (1/54, 1.9%). Cataracts were progressive in seven birds of four species. Unilateral enucleation was performed in 2/54 (3.7%) birds, and 12/54 (22.2%) underwent cataract removal (phacoemulsification in 16 eyes and standard extracapsular cataract extraction in 2 eyes). Concurrent ocular abnormalities, such as corneal scarring and lens-induced uveitis, were seen in 2/18 (11.1%) eyes preoperatively in the group undergoing cataract removal, 2/2 (100%) eyes preoperatively in the group undergoing enucleation, and 33/70 (47.1%) of eyes that did not undergo surgery. For birds undergoing cataract removal, complications included successfully treated cardiorespiratory arrest intraoperatively (1/12, 8.3%) as well as postanesthetic complications of acute respiratory distress and tracheal stricture (2/12, 16.7%). The most common postoperative ocular abnormalities included posterior capsular opacity (4/18 eyes, 22.2%) and corneal scarring (2/18 eyes, 11.1%). Lens cortical regrowth and marked posterior lens capsular opacity occurred in one eye of one bird after phacoemulsification, necessitating a second ocular surgery. A successful outcome, as determined by improved postoperative visual acuity, was seen in 10/12 (83.3%) birds undergoing cataract removal, and 5/12 (41.7%) of these birds were alive >3 yr after surgery. The results of this review will aid clinicians in identifying common stages of cataracts, determining eligibility for cataract surgery, and managing postoperative complications in avian patients.

The prevalence of pseudoexfoliation syndrome in King Hamad University Hospital.

PURPOSE: The aim of this study is to determine the prevalence of pseudoexfoliation syndrome in patients with cataracts in King Hamad University Hospital (KHUH) and rates of complication in pseudoexfoliation (PXF) patients postoperatively and 2-year follow-up. METHODS: A retrospective analysis was conducted on medical records of PXF patients who underwent phacoemulsification and extracapsular cataract extraction in KHUH, Bahrain, between August 31, 2016, and December 30, 2018. RESULTS: From the 458 cases analyzed, there were 17 patients with PXF (3.71%). One patient per-operatively experienced posterior capsular repture (5.88%). Zero patients experienced complication in 2 years of follow-up. CONCLUSION: This is the first study investigating the prevalence rate of PXF in Bahrain and rates of complication for PXF patients undergoing cataract surgery. This study contributes to further understanding the epidemiology of this disease and its racial variation, for PXF patients to better understand the rate of risks involved in cataract surgery, and for surgeons to create appropriate surgical plans that help reduce the risk of complications commonly seen in these patients.

Comparison of visual acuity between phacoemulsification and extracapsular cataract extraction: a systematic review and meta-analysis.

BACKGROUND: Surgical treatment is the primary intervention for cataracts. Extracapsular cataract extraction (ECCE) is a routine surgery for cataracts, phacoemulsification (PE) is another procedure with a small incision and injury area. This study investigated the comparison of the effects of these two procedures on the patient's visual acuity. METHODS: Embase, PubMed, Cochrane Library, and SpringerLink databases were searched from January 2000 to August 2021 to obtain randomized controlled trial (RCT) studies of PE and ECCE procedures for cataract in English. After the initial screening, Revman 5.4 software was used for the meta-analysis. RESULTS: This meta-analysis included a total of eight articles with 1,015 affected eyes. The results showed that the rate of good final visual acuity in the PE group was higher than that in the ECCE group [odds ratio (OR) =2.94, 95% confidence interval (CI): 2.17-3.99, P<0.00001], the incidence of vitreous Loss during PE surgery was lower than that in ECCE surgery (OR =0.16, 95% CI: 0.04-0.64, P=0.01), as was the incidence of capsular tear (OR =0.29, 95% CI: 0.10-0.85, P=0.02), the incidence of capsule opacification after surgery (OR =0.20, 95% CI: 0.08-0.53, P=0.001), and the incidence of cystoid macular edema after surgery (OR =0.16, 95% CI: 0.04-0.74, P=0.02). DISCUSSION: Compared with ECCE, PE demonstrates an improvement in postoperative visual acuity and has fewer complications for cataract patients.

A Case Report of the Triple Procedure in a Patient - Penetrating Keratoplasty, Extracapsular Cataract Extraction, and Posterior Chamber Intraocular Lens Implantation.

The triple procedure, which includes penetrating keratoplasty (PKP), extracapsular cataract extraction (ECCE), and posterior chamber lens implantation (PCIOL), is a surgical preference and a powerful remedy for patients with corneal pathologies and cataracts. In the patient, the PCIOL is implanted into the capsular bag, and the usage of a closed anterior chamber technique is recommended. 10-zero nylon sutures are used in the ten to twelve o'clock positions, and the donor corneal button is added. Continuous curvilinear capsulorhexis (CCC) is accomplished with a capsulotomy inserted through the side port, and the PCIOL is inserted through an open anterior chamber route. This triple system for the remedy of corneal illnesses with cataracts seems to be possible and practical. The following is a case of a 47-year-old patient suffering from a corneal ulcer with pseudocornea due to trauma by an insect in the left eye. He was referred to the department of ophthalmology with complaints of diminution of vision, gradual and progressive, which is associated with excessive watering of the eyes and redness.

Visual Outcome of Phacoemulsification versus Small Incision Cataract Surgery in Pseudoexfoliation Syndrome - A Pilot Study.

INTRODUCTION: Available data has highlighted the efficacy of both Phacoemulsification (PHACO) and Small Incision Cataract Surgery (SICS) in the presence of Pseudoexfoliation (PEX) syndrome. In developing countries, both are commonly performed procedures for cataract extraction. But, no direct comparison between these two procedures is available in the setting of PEX syndrome. With this lacuna in mind, this pilot study decided to compare the visual outcomes of both these techniques in the setting of PEX syndrome. AIM: To compare and analyze the efficacy and safety of PHACO versus SICS in patients of PEX syndrome who underwent cataract surgery. MATERIALS AND METHODS: A prospective, conveniently sampled, observational, pilot study was conducted over six months in ophthalmology department of a tertiary eye institute in India. A total of 200 eyes of 100 patients conforming to pre-defined criteria were conveniently sampled and allotted to two groups of 50 patients each. First group underwent PHACO and second underwent SICS. The demographic profile, pre-operative, intra-operative and post-operative details and complications as well as visual acuity were recorded. Data obtained was analyzed using chi-square test. Statistical significance was set at 95% Confidence Intervals (CI), i.e., at a p-value of <0.05. RESULTS: Of 76 males and 24 females, the mean age was 67.95 years. No statistically significant differences were observed between PHACO and SICS groups with regards to intra-operative complications {overall n=13 in PHACO versus n=21 in SICS, p=0.13}. Controlled sphincterotomy was required in a significantly higher number of SICS cases (p=0.03). No statistically significant differences were observed in terms of post-operative complications (overall n=5 in PHACO versus n=10 in SICS, p=0.26). CONCLUSION: With careful pre-operative assessment, due to intra-operative modifications and surgical expertise, both PHACO and SICS are apparently safe procedures in PEX syndrome.

Safety and Efficacy of the Transition from Extracapsular Cataract Extraction to Manual Small Incision Cataract Surgery in Prevention of Blindness Campaigns.

PURPOSE: To compare the safety and the visual outcomes of two experienced cataract surgeons who converted from extracapsular cataract extraction (ECCE) to manual small incision cataract surgery (MSICS) during a campaign for the prevention of blindness. METHODS: Two surgeons used the ECCE technique (ECCE group) during a campaign in Burkina Faso on 93 consecutive cataract patients with a corrected distance visual acuity (CDVA) <20/80 in the best eye. Both surgeons used MSICS for the first time on 98 consecutive cases in another campaign in Kenya after theoretical instructional courses. RESULTS: There were no significant differences in CDVA at 3 months postoperatively. There were 69% of eyes with uncorrected distance visual acuity ≥20/60 in the MSICS group and 49% eyes in the ECCE group. Spherical equivalents ranged between -1D and +1D in 55% of the MSICS group versus 43% in the ECCE group. There were significant differences in the changes in the vertical component of astigmatism (J45) but not the horizontal (J0) component. There were no significant differences in the intraoperative complications. The most common postoperative complication was corneal edema on the first day in 40.86% and 19.38% of the ECCE and MSICS groups, respectively. CONCLUSION: Transitioning from ECCE to MSICS for experienced cataract surgeons in surgical campaigns is safe. The rate of complications is similar for both techniques. Slightly better visual and refractive outcomes can be achieved due to the decreased induction of corneal astigmatism.

Conventional extracapsular cataract extraction and its importance in the present day ophthalmic practice.

PURPOSE: A retrospective study aimed to evaluate high risk cases where conventional Extracapsular cataract extraction (ECCE) was performed, their intra-operative and post-operative outcomes. SETTING: Sri Srinivasa Sankara Nethralaya (Tirupati) Tirumala Tirupati Devastanams Central Hospital, Tirupati, India. SUBJECTS AND METHODS: Retrospective study of 207 patients who underwent ECCE at the hospital between august 2010 to June 2012. Operative data included details like grade of risk, intra and postoperative complications and visual outcome. RESULTS: Out of 207 cases, 188 were in group 3 (moderate risk, 3-5 points) and 19 in group 4 (high risk, 6 points or more). The intra operative complications in group 3 were 8 (0.042%) and none in group 4. Final best corrected visual acuity (BCVA) of 6/12 and more were 184 (88.88%). Final refraction of less than 2.0 astigmatism was seen in 80.19% (n=166). CONCLUSION: Segregation of cases depending on the risk factors can lead to lower intra operative complications and therefore good postoperative outcome. We believe that phacoemulsification, manual small incision cataract surgery (MSICS) and ECCE each has its own importance and should be used as per the cataract with risk factors.

Factors Associated with Complications and Postoperative Visual Outcomes of Cataract Surgery; a Study of 1,632 Cases.

PURPOSE: Cataract surgery is the most common intraocular surgery performed all over the world and has advanced technically in recent years. As in all surgeries, complications are unavoidable. Herein we report factors associated with complications and visual outcomes of cataract surgery. METHODS: This retrospective cohort study included data of 1,632 cataract surgeries performed from 2007 to 2010 which was obtained from the cataract registry of the Malaysian National Eye Database. Demographic features, ocular and systemic comorbidites, grade of surgeon expertise and duration of surgery, type of anesthesia, intraoperative and postoperative complications, and the type of intraocular lens were recorded. Best corrected visual acuities were compared before and after the operation. RESULTS: Mean patient age was 66.9 years with equal gender distribution. The majority of subjects had age related cataracts. Phacoemulsification was done faster than other surgeries, especially by specialist surgeons. History of prior ocular surgery and operations performed under general anesthesia were associated with greater complications. Phacoemulsification was associated with less complications and better visual outcomes. The age and etiology of cataract did not affect complications. Malays, absence of ocular comorbidities, left eyes and eyes operated under local anesthesia were more likely to experience more visual improvement. Gender, age, cause of cataract, systemic comorbidities and surgeon expertise as well as intra-and postoperative complications did not affect the visual outcomes. CONCLUSION: Phacoemulsification had good visual outcomes in cataract surgery. Duration of surgery, expertise of the surgeon and complications did not affect the visual outcomes.

Outcome of phacoemulsification and extracapsular cataract extraction: A study in a district hospital in Malaysia.

AIM: The aim of the study was to compare the outcomes of phacoemulsification (Phaco) and extracapsular cataract extraction (ECCE) in a district hospital setting. METHODS: A retrospective analysis was done from the medical records of the patients who underwent Phaco and ECCE in Temerloh District Hospital, Pahang state between October 2009 and September 2010. The age, gender and ethnicity of the patients, intraoperative and postoperative complications, and the best corrected visual acuity at the last follow-up visit were noted. Statistical analysis was done using Stata Software Version 11.0. The results of the two procedures were compared. RESULTS: Out of the 179 cataract surgeries performed, 146 cases were Phaco and 33 were ECCE. In our study, 82 were men and 97 were women. The age of patients ranged from 39 to 82 years; majority of the patients (71.3%) were more than 60 years of age. There was a significant association between type of surgery and outcome of visual acuity (p = 0.001). There was no significant association between intraoperative complication and type of surgery (p = 0.166). Postoperative complications of the surgeries were not significantly different. Good visual outcome was noted in 80.1% of eyes operated by Phaco compared to 48.5% of eyes operated by ECCE procedure. CONCLUSION: Since the visual outcome was significantly better in Phaco compared to ECCE procedure (p = 0.001), we recommend that Phaco equipments should be supplied in the district hospitals with adequate facilities for performing intraocular surgery.

Sushruta in 600 B.C. introduced extraocular expulsion of lens material.

It is generally accepted that Jacques Daviel introduced in the 18th century the extracapsular technique of extraction of the lens while the couching method of cataract operation had already been practiced since ancient times. Present study analyses the first known cataract surgery description in three translations into English from the original Sanskrit Sushruta textbook and all the available literature on the subject. We found evidences that some sort of extraocular expulsion of lens material through a limbal puncture (paracentesis) was described by the Indian surgeon. Nevertheless, this incision cannot be considered as a classic extracapsular procedure because it was not large enough to allow the extraction of the entire lens.

Long-term change in intraocular pressure after extracapsular cataract extraction with posterior chamber intraocular lens implantation versus phacoemulsification with posterior chamber intraocular lens implantation in Indians.

PURPOSE: The purpose of the study is to evaluate the long-term changes in intraocular pressure (IOP) after extracapsular cataract extraction (ECCE) with posterior chamber intraocular lens (PCIOL) implantation versus phacoemulsification with PCIOL implantation in otherwise normal cataract patients in India. MATERIALS AND METHODS: The study was conducted in the Department of Ophthalmology, King George's Medical College, Lucknow between August 2000 and August 2001. One hundred and seventeen eyes of 115 patients were included in the study. 84 patients were randomly selected for ECCE with PCIOL implantation (ECCE group) and 31 patients were selected for phacoemulsification with PCIOL implantation (Phaco group). IOP was measured pre-operatively and post-operatively, from the 1(st) month to the 12(th) month. Statistical significance was indicated by P > 0.05. RESULTS: There was a mean fall in IOP of 2.70 mm Hg (19.74%) in the ECCE group and 2.74 mm Hg (20.57%) in the phaco group. The decrease in the mean post-operative IOP from baseline was statistically significant (P > 0.01) at the end of 2 months in both groups. There was no statistically significant difference in post-operative IOP at any visit between groups (P < 0.05, all post-operative visits). After 4(th) monthpost-operatively, the IOP was mostly stable, but it was significantly lower than the pre-operative IOP. CONCLUSION: Significant IOP reduction may be expected after cataract surgery with either ECCE or phacoemulsification with IOL implantation. The lowering of IOP became statistically significant at about 2 months post-operatively, but became almost stable after the 4(th) month.

Simultaneous penetrating keratoplasty and cataract surgery.

PURPOSE: To determine the clinical outcomes of simultaneous penetrating keratoplasty (PK), cataract removal and intraocular lens implantation (triple procedure), and to compare the safety and efficacy of two different cataract extraction techniques during the course of PK. METHODS: This retrospective comparative study was conducted on patients who had undergone a triple procedure. The technique of cataract extraction was either open- sky extracapsular cataract extraction (ECCE) or phacoemulsification (PE). In the ECCE group, the posterior chamber intraocular lens (PCIOL) was implanted in the ciliary sulcus, while in the PE group PCIOLs were fixated within the capsular bag. Outcome measures included best spectacle corrected visual acuity (BSCVA), refractive results, graft clarity and complications. RESULTS: Seventy-six eyes of 69 consecutive patients with mean age of 61.4±14.2 years were enrolled. Mean follow-up period was 61.4±37.2 months over which mean BSCVA was significantly improved from 1.40±0.68 to 0.44±0.33 LogMAR (P<0.001). Mean postoperative spherical equivalent refractive error was -2.13±3.02 D, which significantly differed from the target refraction (-0.73±0.29 D, P=0.004). At final follow-up, 89.5% of the corneal grafts remained clear. CONCLUSION: The triple procedure is a safe and effective approach to restore vision in patients with coexisting corneal pathologies and cataracts. However, unacceptable postoperative refractive error can be anticipated.

Outcome of endophthalmitis treatment in a tertiary referral center in southern iran.

PURPOSE: The purpose of this study was to investigate the causative organisms, the clinical characteristics, visual outcomes, and the incidence of acute endophthalmitis after cataract surgery. MATERIALS AND METHODS: In this retrospective study, a chart review was performed for patients treated in a tertiary referral center for acute endophthalmitis after cataract surgery from January 2005 to December 2009. During the study period, 62 additional patients with acute postoperative endophthalmitis were referred to and treated in this center. Therefore the cohort comprised 70 patients (8 of whom underwent cataract surgery at our center, and 62 who were referred). Demographic, clinical, and laboratory data were analyzed. The primary outcome measure was final visual acuity. P<0.05 indicated statistical significance RESULTS: During the study period, 7737 cataract surgeries were performed in this center. Eight (0.10%) of 7737 eyes developed acute postoperative endophthalmitis. Subgroup analysis indicated that extracapsular cataract extraction was associated with a fourfold higher risk of endophthalmitis compared with phacoemulsification. We found better initial visual acuity (VA) (≥ hand motion) (P<0.001) and negative cultures (P=0.021) were independently associated with a more favorable visual outcome. Patients with relative afferent papillary defect (RAPD) were associated with lower initial VA (P<0.001) and worse visual outcome (P=0.001). Positive microbial cultures were found for 33 (42.9%) cases. Staphylococcus aureus was the most common organism isolated. Positive cultures were more frequently found in patients with RAPD. The "gram-positive coagulase-negative" and "no growth" groups had the best visual outcome. Associated keratitis and avoiding intraocular steroids were associated with the risk of evisceration. CONCLUSION: The visual outcome after endophthalmitis was generally poor and only one eighth of the eyes achieved a final corrected visual acuity of ≥20/200. Therefore, better treatment strategies are warranted. Immediate treatment is essential and the role of primary vitrectomy requires further investigation. In addition, RAPD, as an objective test, may complement VA for predicting the prognosis and planning the course of treatment.

Capsulorhexis: Pearls and pitfalls.

A critical step in phacoemulsification (as well as extracapsular cataract extraction) is making a window in anterior capsule wall (i.e. anterior capsulotomy). Continuous Curvilinear Capsulorhexis (CCC) has become recognized as the standard method of anterior capsulectomy. Techniques employed for CCC have undergone sustained evolution. The present review evaluates elementary principles of CCC. Management of CCC in the presence of small pupil and pseudoexfoliation syndrome is discussed. Main differences of pediatric CCC from its adult-style counterpart and finally several techniques of rescue of an extending capsulorhexis are also reviewed.

Six year Trend in Cataract Surgical Techniques in Iran.

PURPOSE: To determine the cataract surgery techniques performed in Iran from 2000 to 2005. MATERIALS AND METHODS: This study was part of the Iranian Cataract Surgery Survey (ICSS) which was a retrospective cross-sectional study. All major ocular surgery units and 10% of randomly selected minor units throughout Iran were included. Excluding the 2 week Iranian New Year holiday, 1 week per season between 2000 and 2005 (a total of 24 weeks) was selected for each center, and data on all cataract surgeries performed during these weeks were collected by reviewing patient records. The ANOVA repeated measure test was performed to determine longitudinal changes with a P<0.05 denoting statistical significance. RESULTS: Phacoemulsification with intraocular lens (IOL) implantation has become the surgical method of choice in Iran, increasing from less than 7% in 2000 to 57% in 2005 (P<0.0001). Extracapsular cataract extraction showed a reverse trend compared to phacoemulsification, decreasing from greater than 91% in 2000 to 41% in 2005 (P<0.0001). Intracapsular cataract extraction and lensectomy were rarely performed without significant changes over time (P>0.05). CONCLUSION: Phacoemulsification with IOL implantation has become the preferred cataract surgery method in Iran during recent years.

Resultados de tres alternativas quirúrgicas para la remoción del cristalino en el cierre angular primario agudo / Results of three surgical alternatives for the crystalline lens extraction in the acute primary angle- closure

Objetivo: evaluar la efectividad de la remoción del cristalino en el tratamiento del cierre angular primario agudo. Métodos: se realizó un estudio descriptivo, longitudinal y prospectivo de serie de casos en 27 ojos de igual número de pacientes con cierre angular primario agudo, distribuidos en tres alternativas: facoemulsificación (faco n= 7), túnel esclerocorneal (túnel n= 12) y túnel postrabeculectomía (túnel pos-TBT n= 8).Se analizaron las variables presión intraocular y número de colirios hipotensores en preoperatorio y posoperatorio a la semana, al mes, a los tres y a los seis meses, al año y a los dos años, así como las variables esfera, cilindro y agudeza visual mejor corregida en preoperatorio y a los dos años posoperatorios. Resultados: la presión intraocular posoperatoria fue estable en el tiempo en los 3 grupos (12-14 mmHg). A los dos años hubo reducción significativa de presión intraocular media en grupo túnel (3,83 ± 5,27 mmHg; p= 0,032); del número de colirios hipotensores en grupo faco (1,29 a 0,14; p= 0,038) y del grupo túnel (1,33 a 0,25; p= 0,006). Se indujo miopía en grupo túnel pos-TBT (-1,16 ± 1,12 D; p= 0,028) y astigmatismo en grupo túnel (1,00 ± 1,05 D; p= 0,016). La agudeza visual mejor corregida promedio se incrementó en los tres grupos, con significación en los grupos túnel y túnel pos-TBT (p= 0,003 y p= 0,012 respectivamente). Conclusiones: en pacientes con cierre angular primario agudo, la facoemulsificación y el túnel esclerocorneal reducen la presión intraocular y el número de colirios hipotensores en el mediano plazo de dos años, a la vez que se mantiene el poder hipotensor de una filtrante previa. Las tres variantes recuperan de manera efectiva la agudeza visual, mientras se induce el error miópico de 1 dioptría en pacientes con trabeculectomía previa y astigmatismo de 1 dioptría mediante túnel esclerocorneal(AU)

Objective: to evaluate the effectiveness of the crystalline lens extraction in the treatment of the acute primary angle-closure. Methods: prospective, longitudinal and descriptive study of a case series of 27 eyes from the same number of patients suffering acute primary angle-closure, distributed according to three alternatives: phacoemulsification (n=7, phaco), sclerocorneal tunnel (n=12, tunnel)and postrabeculectomy tunnel ( n=8, post-TBT tunnel). The variables intraocular pressure and number of hypotensive eyedrops used in the preoperative and postoperative period were analyzed a week, a month, three months, six months, one year and two years after the surgery as well as sphere, cylinder and best corrected visual acuity in the preoperative phase and two years after surgery. Results: postoperative intraocular pressure was steady in the course of time in the three groups (12-14 mmHg). Two years later, there had been a significant reduction of average intraocular pressure in the tunnel group (3.83 ± 5.27 mmHg; p= 0.032), of the number of hypotensive eyedrops used in the phaco group (1.29 to 0.14; p= 0.038) and the tunnel group (1.33 to 0.25; p= 0.006). Myopia in the post-TBT tunnel group(-1.16 ± 1.12 D; p= 0,028) and astigmatism in the tunnel group(1.00 ± 1.05 D; p= 0.016) were both induced. The best average corrected visual acuity increased in the three groups, being significant in the tunnel and the post-TBT tunnel groups (p= 0.003 and p= 0.012, respectively. Conclusions: in those patients with acute primary angle-closure, phacoemultification and sclerocorneal tunnel reduce the intraocular pressure and the number of hypotensive eyedrops to be used in 2 years-term and the hypotensive power of a previous filtering bleb. The three variants can effectively recover the visual acuity whereas the myopic error of one diopter is induced in patients with previous trabeculectomy and one diopter astigmatism through the sclerocorneal tunnel(AU)

Phacoemulsification versus extracapsular extraction: governmental costs.

PURPOSE: To evaluate the governmental costs of patients undergoing phacoemulsification and extracapsular cataract extraction at a public hospital in a developing country. METHODS: A prospective study was conduced with 205 patients. The subjects were randomized for cataract surgery using either phacoemulsification or extracapsular cataract extraction techniques. RESULTS: Of the 205 patients, 101 patients were submitted to phacoemulsificationand 104 patients were submitted to extracapsular cataract extraction. Brazilian Health Care System expenditures for the surgery and the postoperative period were US$ 95.49 more in the phacoemulsification group than in the extracapsular cataract extractiongroup. If we take into account Social Security expenditures, then we estimate that the average difference for the total direct cost for the government for the surgery and the postoperative period for both procedures was US$ 50.91 or approximately half of the initial difference in cost for the phacoemulsification surgery. The total cost of cataract surgery for the government (excluding social security) was estimated at US$ 258.79 for extracapsular cataract extraction and US$ 309.70 for phacoemulsification per patient. Focusing only on working patients, the total cost was US$ 342.21 for phacoemulsification and US$ 587.71 for extracapsular cataract extraction, a difference of US$ 245.50. This difference can be considered monetarily and socially justifiable when the benefits of the surgical technique are evaluated. CONCLUSION: Under the conditions of this study, we observed that phacoemulsification was an efficient procedure with regard to the impact on public health care system, when all costs are assessed comprehensively, mainly for subjects with regular jobs.

The incidence and rate of rhegmatogenous retinal detachment seven years after cataract surgery in patients with high myopia.

BACKGROUND: Cataract extraction is the most commonly performed surgery in the National Health Service. Myopia increases the risk of postoperative rhegmatogenous retinal detachment (RRD). The aim of this study was to determine the incidence and rate of RRD seven years after cataract extraction in highly myopic eyes. METHODS: Retrospective review was performed of notes of all high myopes (axial length 26.0 mm or more) who underwent cataract extraction during the study period in one centre. RESULTS: 84 eyes met the study criteria. Follow-up time from surgery was 93 to 147 months (median 127 months). The average axial length was 28.72 mm (sd 1.37). Two eyes developed post-operative RRD; the incidence was 2.4% and the rate one RRD per 441.6 person-years. The results of 15 other studies on the incidence of RRD after cataract extraction in high myopia were pooled and combined with our estimate. CONCLUSION: Both patients in our study who developed RRD had risk factors for this complication as well as high myopia. Risk factors are discussed in the light of our results and the pooled estimate. Our follow-up time is longer than most. Future case series should calculate rates to allow meaningful comparison of case series.

Phacoemulsification versus extracapsular extraction: governmental costs

PURPOSE: To evaluate the governmental costs of patients undergoing phacoemulsification and extracapsular cataract extraction at a public hospital in a developing country. METHODS: A prospective study was conduced with 205 patients. The subjects were randomized for cataract surgery using either phacoemulsification or extracapsular cataract extraction techniques. RESULTS: Of the 205 patients, 101 patients were submitted to phacoemulsificationand 104 patients were submitted to extracapsular cataract extraction. Brazilian Health Care System expenditures for the surgery and the postoperative period were US$ 95.49 more in the phacoemulsification group than in the extracapsular cataract extractiongroup. If we take into account Social Security expenditures, then we estimate that the average difference for the total direct cost for the government for the surgery and the postoperative period for both procedures was US$ 50.91 or approximately half of the initial difference in cost for the phacoemulsification surgery. The total cost of cataract surgery for the government (excluding social security) was estimated at US$ 258.79 for extracapsular cataract extraction and US$ 309.70 for phacoemulsification per patient. Focusing only on working patients, the total cost was US$ 342.21 for phacoemulsification and US$ 587.71 for extracapsular cataract extraction, a difference of US$ 245.50. This difference can be considered monetarily and socially justifiable when the benefits of the surgical technique are evaluated. CONCLUSION: Under the conditions of this study, we observed that phacoemulsification was an efficient procedure with regard to the impact on public health care system, when all costs are assessed comprehensively, mainly for subjects with regular jobs.