Outcome of cataracts surgery.docx

7/28/2019 Outcome of cataracts surgery.docx

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Khartoum College of Medical Sciences

Department of Community Medicine

Outcome of Cataract Surgery In Makkah

Eye Hospital

Done by :Ziryab Zein Elabdein Mohamed

Supervisor : DrMona Muna Hassan, mbbsMBBS,MD

Department of community medicine

Khartoum College of medical sciences

Email: [email protected]


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CONTENTS1.Introduction

2.Objectives3.Literature review4.Methodology5.Results6.Discussion7.Conclusion8.Annex: questionnaire9.Recommendation

10.References


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Introduction

A cataract is a clouding of the lens inside the eye which leads to a

decrease in vision. It is the most common cause of blindness and is

conventionally treated with surgery. Visual loss occurs because

opacification of the lens obstructs light from passing and being focused

on to the retina at the back of the eye.[1]

It is most commonly due to biological agingbut there are a wide variety

of other causes. Over time, yellow-brown pigment is deposited withinthe lens and this, together with disruption of the normal architecture of

the lens fibers, leads to reduced transmission of light, which in turn leads

to visual problems.

As cataracts develop very slowly most people do not know they have

them at first. However, the clouding progresses and vision will gradually

get worse. Stronger lighting and eyeglasses can help improve vision.

Nevertheless, eventually the vision impairment affects the patient's

ability to carry out everyday tasks. At this point the individual will need

surgery. Fortunately, cataract surgery is usually a very effective and safeprocedure.

A mature cataract is one in which all of the lens protein is opaque while

the immature cataract has some transparent protein.

Those with cataract commonly experience difficulty appreciating colors

and changes in contrast, driving, reading, recognizing faces, and

experience problems coping with glare from bright lights.
http://en.wikipedia.org/wiki/Lens_%28anatomy%29http://en.wikipedia.org/wiki/Eyehttp://en.wikipedia.org/wiki/Opacity_%28optics%29http://en.wikipedia.org/wiki/Retinahttp://en.wikipedia.org/wiki/Cataract#cite_note-1http://en.wikipedia.org/wiki/Cataract#cite_note-1http://en.wikipedia.org/wiki/Cataract#cite_note-1http://en.wikipedia.org/wiki/Senescencehttp://en.wikipedia.org/wiki/Senescencehttp://en.wikipedia.org/wiki/Cataract#cite_note-1http://en.wikipedia.org/wiki/Retinahttp://en.wikipedia.org/wiki/Opacity_%28optics%29http://en.wikipedia.org/wiki/Eyehttp://en.wikipedia.org/wiki/Lens_%28anatomy%29


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Epidemiology and magnitude

Age-related cataract is responsible for 48% of world blindness,which represents about 18 million people, according to the World

Health Organization (WHO). In many countries surgical services

are inadequate, and cataracts remain the leading cause of

blindness.

As populations age, the number of people with cataracts isgrowing. Cataracts are also an important cause of low vision in

both developed and developing countries. Even where surgicalservices are available, low vision associated with cataracts may

still be prevalent, as a result of long waits for operations and

barriers to surgical uptake, such as cost, lack of information and

transportation problems.

In the United States, age-related lenticular changes have beenreported in 42% of those between the ages of 52 to 64, 60% of

those between the ages 65 and 74, and 91% of those between the

ages of 75 and 85.

Causes of cataracts

Aging Genetics Trauma Radiation Skin diseases Medication
http://www.news-medical.net/health/What-are-Cataracts.aspxhttp://www.news-medical.net/health/What-are-Cataracts.aspxhttp://www.news-medical.net/health/What-are-Cataracts.aspxhttp://www.news-medical.net/health/What-are-Cataracts.aspx


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Symptoms of Cataracts

Cataracts usually form slowly and cause few symptoms until they

noticeably block light. When symptoms are present, they can include:

Vision that is cloudy, blurry, foggy, or filmy Progressive nearsightedness in older people often called "second

sight" because they may no longer need reading glasses.

Changes in the way you see color because the discolored lens actsas a filter.

Problems driving at night such as glare from oncoming headlights. Problems with glare during the day. Double vision (like a superimposed image). Sudden changes in glasses prescription.

Diagnosis

Either an ophthalmologist or an optometrist can examine patients for

cataracts, but only ophthalmologists are qualified to treat cataracts.

The eye professional can observe cloudy areas on the lenses with a

direct physical examination, even before the cataracts begin to interfere

with vision. Cameras can measure the cataract density. Various vision

tests are also performed.

Visual acuity test. This eye chart test measures how well you see at

various distances.

Dilated eye exam. Drops are placed in your eyes to widen, or dilate, the

pupils. Your eye care professional uses a special magnifying lens to

examine your retina and optic nerve for signs of damage and other eye


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problems. After the exam, your close-up vision may remain blurred for

several hours.

Tonometry. An instrument measures the pressure inside the eye.

Numbing drops may be applied to the eye for this test.

Eye care professional also may do other tests to learn more about the

structure and health of your eye.

Treatment

The symptoms of early cataract may be improved with new eyeglasses,

brighter lighting, anti-glare sunglasses, or magnifying lenses. If these

measures do not help, surgery is the only effective treatment. Surgery

involves removing the cloudy lens and replacing it with an artificial lens.

A cataract needs to be removed only when vision loss interferes with

everyday activities, such as driving, reading, or watching TV. The

patient and the eye care professional can make this decision together. In

most cases, delaying cataract surgery will not cause long-term damage to

your eye or make the surgery more difficult.

Sometimes a cataract should be removed even if it does not cause

problems with your vision. For example, a cataract should be removed if

it prevents examination or treatment of another eye problem, such as

age-related macular degeneration or diabetic retinopathy. If thr eye care

professional finds a cataract, patients may not need cataract surgery for

several years. In fact, they might never need cataract surgery. By having

vision tested regularly, eye care professional can discuss if and when

you might need treatment.

If there is cataracts in both eyes that require surgery, the surgery will beperformed on each eye at separate times, usually four to eight weeks

apart.


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Cataract surgery is the removal of the natural lens of the eye (also called

"crystalline lens") that has developed an opacification, which is referred

to as a cataract. Metabolic changes of the crystalline lens fibers over

time lead to the development of the cataract and loss of transparency,

causing impairment or loss ofvision. Many patients' first symptoms are

strong glare from lights and small light sources at night, along with

reduced acuity at low light levels. During cataract surgery, a patient's

cloudy natural lens is removed and replaced with a synthetic lens to

restore the lens's transparency.

Following surgical removal of the natural lens, an artificial intraocular

lens implant is inserted (eye surgeons say that the lens is "implanted").

Cataract surgery is generally performed by an ophthalmologist (eye

surgeon) in an ambulatory (rather than inpatient) setting, in a surgical

center or hospital, using local anesthesia (either topical, peribulbar, or

retrobulbar), usually causing little or no discomfort to the patient. Well

over 90% of operations are successful in restoring useful vision, with a

low complication rate. Day care, high volume, minimally invasive, small

incision phacoemulsification with quick post-op recovery has becomethe standard of care in cataract surgery all over the world.
http://en.wikipedia.org/wiki/Lens_%28anatomy%29http://en.wikipedia.org/wiki/Human_eyehttp://en.wikipedia.org/wiki/Cataracthttp://en.wikipedia.org/wiki/Visual_perceptionhttp://en.wikipedia.org/wiki/Intraocular_lenshttp://en.wikipedia.org/wiki/Intraocular_lenshttp://en.wikipedia.org/wiki/Ophthalmologyhttp://en.wikipedia.org/wiki/Phacoemulsificationhttp://en.wikipedia.org/wiki/Phacoemulsificationhttp://en.wikipedia.org/wiki/Ophthalmologyhttp://en.wikipedia.org/wiki/Intraocular_lenshttp://en.wikipedia.org/wiki/Intraocular_lenshttp://en.wikipedia.org/wiki/Visual_perceptionhttp://en.wikipedia.org/wiki/Cataracthttp://en.wikipedia.org/wiki/Human_eyehttp://en.wikipedia.org/wiki/Lens_%28anatomy%29


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Types of surgery

Cataract surgery, using a temporal approach phacoemulsification probe

(in right hand) and "chopper"(in left hand) being done under operating

microscope at a Navy medical center

Cataract surgery recently performed, foldable IOL inserted. Note small

incision and very slight hemorrhage to the right of the still dilated pupil.

There are a number of different surgical techniques used in cataract

surgery:

Phacoemulsification (Phaco) is the most common technique used

developed countries. It involves the use of a machine with an ultrasonichandpiece equipped with a titanium or steel tip.

The tip vibrates at ultrasonic frequency (40,000 Hz) and the lens

material is emulsified. A second fine instrument (sometimes called a

"cracker" or "chopper") may be used from a side port to facilitate

cracking or chopping of the nucleus into smaller pieces.

Fragmentation into smaller pieces makes emulsification easier, as well

as the aspiration of cortical material (soft part of the lens around the

nucleus).
http://en.wikipedia.org/wiki/Hemorrhagehttp://en.wikipedia.org/wiki/Phacoemulsificationhttp://en.wikipedia.org/wiki/Emulsificationhttp://en.wikipedia.org/wiki/Emulsificationhttp://en.wikipedia.org/wiki/Phacoemulsificationhttp://en.wikipedia.org/wiki/Hemorrhage


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After phacoemulsification of the lens nucleus and cortical material is

completed, a dual irrigation-aspiration (I-A) probe or a bimanual I-Asystem is used to aspirate out the remaining peripheral cortical material.

Manual small incision cataract surgery (MSICS): This technique is an

evolution of ECCE (see below) where the entire lens is expressed out of

the eye through a self-sealing scleral tunnel wound. An appropriately

constructed scleral tunnel is watertight and does not require suturing.

The "small" in the title refers to the wound being relatively smaller than

an ECCE, although it is still markedly larger than a phaco wound.

Head to head trials of MSICS vs phaco in dense cataracts have found no

different in outcomes, but shorter operating time and significantly lower

costs with MSICS.

Extracapsular cataract extraction (ECCE): Extracapsular cataract

extraction involves the removal of almost the entire natural lens while

the elastic lens capsule (posterior capsule) is left intact to allowimplantation of an intraocular lens.

It involves manual expression of the lens through a large (usually 10

12 mm) incision made in the cornea orsclera. Although it requires a

larger incision and the use of stitches, the conventional method may be

indicated for patients with very hard cataracts or other situations in

which phacoemulsification is problematic.

Intracapsular cataract extraction (ICCE) involves the removal of the lens

and the surrounding lens capsule in one piece.
http://en.wikipedia.org/wiki/Corneahttp://en.wikipedia.org/wiki/Sclerahttp://en.wikipedia.org/wiki/Sclerahttp://en.wikipedia.org/wiki/Cornea


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The procedure has a relatively high rate of complications due to the

large incision required and pressure placed on the vitreous body. It hastherefore been largely superseded and is rarely performed in countries

where operating microscopes and high-technology equipment are readily

available.

After lens removal, an artificial plastic lens (an intraocular lens implant)

can be placed in either the anterior chamber or sutured into the sulcus.

Cryoextraction is a form of ICCE that freezes the lens with a cryogenic

substance such as liquid nitrogen. In this technique, the cataract isextracted through use of a cryoextractora cryoprobe whose

refrigerated tip adheres to and freezes tissue of the lens, permitting itsremoval.

Although it is now used primarily for the removal of subluxated lenses,

it was the favored form of cataract extraction from the late 1960s to the

early 1980s
http://en.wikipedia.org/wiki/Vitreous_bodyhttp://en.wikipedia.org/wiki/Plastichttp://en.wikipedia.org/wiki/Intraocular_lenshttp://en.wikipedia.org/wiki/Cryoextraction_%28medicine%29http://en.wikipedia.org/wiki/Liquid_nitrogenhttp://en.wikipedia.org/wiki/Liquid_nitrogenhttp://en.wikipedia.org/wiki/Cryoextraction_%28medicine%29http://en.wikipedia.org/wiki/Intraocular_lenshttp://en.wikipedia.org/wiki/Plastichttp://en.wikipedia.org/wiki/Vitreous_body


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Research objectives

General objectives

The objective of this study is to determine the outcome of Cataracts

surgery in Makkah eye hospital.

Specific objectives

To determine the most common outcome of cataracts surgery atMekka Eye hospitalwhether its success of failure.

To determine the Visual acuity of the study sample before andafter the operation

To determine if anthey association existsbetween the outcome ofthe cataract surgery and the age of the patient.

To determine if anythe association exists between the outcome ofthe cataract surgery and any presentother ocular diseases


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To determine if anythe association existsbetween the outcome ofthe the cataract surgery and any present systemic disease

Literature review

Previous studies have been conducted on the outcome of cataracts

surgery and their results were as follows:-

1: Visual outcome of cataract surgery; Study from the European

Registry of Quality Outcomes for Cataract and Refractive Surgery.

PURPOSE:

To analyze the visual outcome after cataract surgery.

SETTING:

Cataract surgery clinics in 15 European countries.

DESIGN:

Database study.

Comment [a1]:

Rather than listing the abstracts of previ

In the literature review you summarize t

of other studies under subheadings :Eg

Outcome of cataract surgery :

What did other studies find regarding the

and failures

2. factors affecting the outcomes of the

what was the effect of age on outcome a

other studies etc


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METHODS:

Data were drawn from case series of cataract extractions reported to the

European Registry of Quality Outcomes for Cataract and Refractive

Surgery database. These data were entered into the database via the Web

by surgeons or by transfer from existing national registries or electronic

medical record systems. The database contains individual anonymous

data on preoperative, intraoperative, and postoperative measurements.

RESULTS:

Data on 368256 cataract extractions were available for analysis. Thebest visual outcome was achieved in age groups 40 to 74 years, and men

showed a higher percentage of excellent vision (1.0 [20/20] or better)

than women. A corrected distance visual acuity (CDVA) of 0.5 (20/40)

or better and of 1.0 (20/20) or better was achieved in 94.3% and 61.3%

of cases, respectively. Ocular comorbidity and postoperative

complications were the strongest influences on the visual outcome;

however, surgical complications and ocular changes requiring complex

surgery also had a negative influence. Deterioration of visual acuity after

the surgery (n= 6112 [1.7% of all cases]) was most common in patients

with a good preoperative visual acuity.

CONCLUSIONS:

The visual outcomes of cataract surgery were excellent, with 61.3% of

patients achieving a corrected distance visual acuity of 1.0 (20/20) or

better. Age and sex influenced the visual outcomes, but the greatest

influences were short-term postoperative complications, ocular

comorbidity, surgical complications, and complex surgery. A weakness

of the study could be that some of the data is self-reported to the

registry.


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2: National study of cataract surgery outcomes. Variation in 4-

month postoperative outcomes as reflected in multiple outcome

measures.

BACKGROUND

Although ophthalmologists have long recognized that visual acuity alone

is an inadequate measure of visual impairment, the need for and

outcomes of cataract surgery historically have been assessed in terms of

visual acuity.

PURPOSE

To examine the relation among different cataract surgery outcome

measures, including a 14-item instrument designed to measure

functional impairment caused by cataract (the VF-14), at 4 months after

cataract surgery.

METHODS

The authors performed a longitudinal study of 552 patients undergoing

first eye cataract surgery by 1 of 75 ophthalmologists practicing in

Columbus, Ohio, St. Louis, Missouri, or Houston, Texas. Patients were

interviewed, and clinical data were obtained preoperatively (July 15,

1991-March 14, 1992) and 4 months postoperatively.


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RESULTS

The percentage of patients judged to be improved at 4 months after

cataract surgery varied by the outcome measure used: Snellen visual

acuity (96%); VF-14 score (89%); satisfaction with vision (85%); self-reported trouble with vision (80%); and Sickness Impact Profile score

(67%). The change in patients' ratings of their trouble with vision and

their satisfaction with vision were correlated more strongly with the

change in VF-14 score than with the change in visual acuity (operated

eye or better eye). The average change in VF-14 score was unrelated to

the preoperative visual acuity in the eye undergoing surgery.

CONCLUSION

Estimates of the proportion of patients benefiting from cataract surgery

vary with the outcome measure used to measure benefit. Change in VF-14 score, a measure of functional impairment related to vision, may be a

better measure of the benefit of cataract surgery than change in visual

acuity.


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3: Visual functional outcomes of cataract surgery in the United

States, Canada, Denmark, and Spain: report of the International

Cataract Surgery Outcomes Study.

To compare functional outcomes after cataract surgery performed at 4

sites in 4 countries that have been described as having significant

differences in the organization of care and patterns of clinical practice.

SETTING

Multicenter cohort study from the United States, Canada, Denmark, andSpain.

METHODS

Clinical data and patient interview data were collected preoperatively

and 4 months postoperatively. Functional outcomes were assessed by the

Visual Function Index (VF-14), a self-reported measure of visual

function. Scores on the VF-14 range from 0 (maximum impairment) to

100 (no impairment).

RESULTS

Unilateral surgery was performed in 1073 patients. In this subgroup, the

odds of achieving an optimal functional outcome (VF-14 score > or =95)

were similar among sites after controlling for differences in case mix.

Bilateral surgery was performed in 211 patients. A postoperative visual

acuity of 0.50 or better in both eyes was reported in 155 patients.

However, 37% of these patients reported visual function impairment

(VF-14 score


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CONCLUSIONS

A previously identified variation in treatment modalities among the 4

sites did not have a significant effect on the odds of achieving an optimal

functional outcome. In addition to visual acuity measurements, the VF-

14 index provides information on functional outcomes that is useful,

especially in studies assessing the benefits of cataract surgery in a publichealth care setting.

4: Outcome and Monitoring of Cataract Surgical Services at Takeo

Province, Cambodia

Purpose

To evaluate outcome and monitoring of cataract surgical services at

Takeo Eye Hospital, Cambodia

Design

A prospective, hospital-based report using a cataract surgical recordform from the International Center for Eye Health, London.

Methods

Data including preoperative and postoperative visual acuity (VA),

proportion of ocular pathology, intraoperative and postoperative

complications, type of surgery, and causes of poor outcome of all

patients with cataract were collected. Exclusion criteria were age of

patients being younger than 20 years, combined cataract-glaucoma

surgeries, and having traumatic cataract.


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Results

A total of 8211 cataract surgeries were performed from January 2007 to

December 2011. Preoperatively, the presenting VA was less than 6/60 in

65.8%. At discharge, 51.8% had a presenting VA of 6/18 or better.

Outcome was poor (VA < 6/60) in 10.6%. Over 5 years, the percentage

of patients with poor outcome decreased from 12.6% to 8.5%. Total

operative complications decreased from 18.2% in 2007 to 3.3% in 2011,

with a reduction of vitreous loss from 6.5% to 1.8%. Of all surgeries,

21.2% were performed by resident physicians. At the first follow-up 1 to

3 weeks postoperatively, 62.6% of the patients presented, whereas

23.9% presented for a second follow-up after 4 to 6 weeks.

Conclusions

Monitoring of cataract surgical services indicated an increase in quantity

and quality. Hospital-based data collection as recommended by the

World Health Organization action plan for the prevention of avoidable

blindness is possible, but biased data collection has to be considered in

the interpretation of the data.


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5: Monitoring visual outcome of cataract surgery in India

Materials and methodsThe methods consisted of examining the records of patients who had

undergone cataract surgery.

Results

Data from a total of 4168 recent cataract surgical record forms wereanalysed using customized software (written in Epi Info, version 6.04).

Of the surgical procedures undertaken, 54% were performed on males,

65% were on one eye, and 57% were carried out in eye camps. The

following surgical techniques were used: intracapsular cataract

extraction with spectacles (46% of eyes), extracapsular cataract

extraction with spectacles (42%), and extracapsular cataract extraction

with intraocular lensimplantation (11%).

The majority of operations (83.4%) were performed on

eyes with a preoperative visual acuity of


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surgery, with a followup period of 032 years (mean, 6 years) (7). In all,

558 persons had bilateral aphakia and 1285 unilateral aphakia, giving atotal of 2401 operated eyes. Of these, 123 (5.1%) were pseudophakic.

For all operated eyes, outcome was good in 43.5% and poor in 26.4%.

For the 2278 aphakic eyes, the outcome was good in 41.4% and poor in

27.2%, with the available correction. For 31% of eyes with a poor

outcome, the patients had lost or broken their spectacles. Since best

corrected vision was not measured, it is difficult to assess how many

cases of poor and borderline outcome might have benefited from full

spectacle correction. For the 123 pseudophakic eyes, the outcome was

good in 82.1%

and poor in 11.4%. Of the 1962 persons aged550 years examined inAhmedabad district, 484 (24.7%) had undergone cataract surgery, with a

follow-up period of 030 years (mean, 5.5 years) (Limburg et al.,

unpublished data, 1999). In all, 292 persons had bilateral aphakia and

192 unilateral aphakia, giving a total of 776 operated eyes. Of these 189

(24%) were pseudophakic. For all operated eyes, outcome was good in

49.9% and poor in 23.9% with the available correction. For the aphakic

eyes, outcome was good in 44.2% and poor in 28%; and for the 189

pseudophakic eyes, outcome was good in 67.2%

and poor in 11.6%.


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METHODOLOGY

Study design

Type of study to used was observational descriptive cross-sectional and

comparative study. It was based on a single examination of the study

population.

It was more suitable and less time consuming than longitudinal

Studies.

Study area

Makkah Eye Hospital, Khartoum. Department of surgery

Study population

Records ofPatients that underwent cataract surgery in Makkah Eye

Hospital, Khartoum

Inclusion criteria:

Age

Gender..

Duration after surgery.

Comment [a2]: Patients or patients r


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Sampling method

Systematic sampling, individuals were chosen at regular

Intervals of every 5th

person that underwent cataract surgery.

Sample frame

Included all people that underwent cataract surgery in Khartoum

Makkah eye hospital

Sample size

Sample size= p*q*z2

D2

Used 0.1 as prevalence

Q=1-0.1 = 0.9

And constants: z=1.96 ; d=0.05

Sample size= 138

Comment [a3]: Every fifth based on w

did you calculate the interval

It is usually calculated by dividing the tot

of population by the sample size

Comment [a4]: This comes before th

method


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Data collection method

Data base record collection using a check list including:

Data analysis and management

Microsoft Excel and SPSS were used for data analysis.

Comment [a5]: Put the list of variable


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ResultsBelow is the table used for classifying the resultsthe outcome of cataract

surgery. There was no missing data in the results.

Categories of Visual Impairment

CATEGORY

Corrected

VA-Better

Eye

WHO Definition Working Indian Definition

6/6-6/18 Normal Normal Normal


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Frequency Tables

Table (1) showing the Age distribution of the study population, Mekka

Eye hospital, Khartoum, 2013

Frequency Percent

1-30 8 5.5

31-60 51 35.2

61-90 86 59.3

Total 145 100.0

The majority of the study population (59.3%) was in the age group 61 to

90 years , followed by those in age group 31- to 60 (35.2%)

NPL Blind Total Blindness Total Blindness

Comment [a7]: Write the title in full l

all other tables as shown


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Gender

Frequency Percent

Female 44 30.3

Male 101 69.7

Total 145 100.0

Diagnosed Eye

Frequency Percent

Left 69 47.6

Right 76 52.4

Total 145 100.0

Diagnosis

Frequency Percent

Comment [a8]: You should write a br

description below each table


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Cataract -

Immature

125 86.2

Cataract - Mature 20 13.8

Total 145 100.0

Associated Disease

Frequency Percent

Absent 133 91.7

Present 12 8.3

Total 145 100.0

Systemic Diagnosis

Comment [a9]: Bring you previous ta

contains the details of the associated dei

is used for cross tabulation only

Comment [a10]: Details

Comment [a11]: The same as for abo


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Frequency Percent

Absent 117 80.7

Present 28 19.3

Total 145 100.0

Type Of Surgery

Frequency Percent

ECCE 3 2.1

ECCE + PC IOL 16 11.0

ICCE + IOL 1 .7

Phaco + PC IOL 125 86.2

Total 145 100.0

Comment [a12]: Details


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Pre-operative VA

Frequency Percent

3/60 18 12.4

6/12 1 .7

6/18 9 6.2

6/24 8 5.5

6/36 10 6.9

6/6 1 .7

6/60 10 6.9

FC 1 ft 24 16.6

Comment [a13]: Delete this table


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FC 2 ft 8 5.5

HM 38 26.2

LP 18 12.4

Total 145 100.0

Pre-Operative VA (WHO classification)

Frequenc

y

Percent

Normal11 7.6

Visual Impairment28 19.3

Severe visual

impairment

18 12.4


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Blind

88 60.7

Total145 100.0

Post-operative VA

Frequency Percent

3/36 1 .7

3/60 26 17.9

6/12 17 11.7

6/18 34 23.4

6/24 8 5.5

6/36 15 10.3

6/6 2 1.4

6/60 7 4.8

Comment [a14]: Delete this table


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6/9 6 4.1

FC 1 ft 16 11.0

FC 2 ft 3 2.1

HM 10 6.9

Total 145 100.0

Post-Operative VA (WHO classification )

Frequency Percent

Normal59 40.7

Visual impairment29 20.0

Severe visual

impairment

27 18.6

Blind30 20.7

Total

145 100.0


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Surgery Outcome

Frequency Percent

Success116 80

Failure29 20

Total145 100

Bar Charts


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Comment [a15]: You either put a tab

diagram for the same result

No need to put them both


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36/49


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Surgery Outcome * the association between age of

the patient and the cataract surgeru outcome Age

Cross tabulation

Age Total

1-30 31-60 61-90

Surgery

Outcome

Success 87.5% 86.3% 75.6% 80.0%

Failure 12.5% 13.7% 24.4% 20.0%

Total100.0

%

100.0

%

100.0

%

100.0

%

Chi square= 2.586 p value = .275

There was no statistically significant effect of patiens age on the

outcome of cataract surgey (p value> 0.05)

Chi-Square Tests

Value df Asymp. Sig. (2-

sided)

Pearson Chi-Square2.586

a 2 .275

Formatted Table


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Surgery Outcome * Gender Cross tabulation

Gender Total

Female Male

Surgery OutcomeSuccess

77.3% 81.2% 80.0%

Failure 22.7% 18.8% 20.0%

Total100.0% 100.0% 100.0%

Chi-Square Tests


sided)

Pearson Chi-Square

.294a

1 .588


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Surgery Outcome Associated Diagnosis Cross tabulation

Associated

Diagnosis

Total

Absent Present

Surgery

Outcome

Succe

ss

80.5% 75.0% 80.0%

Failur

e

19.5% 25.0% 20.0%

Total100.0

%

100.0

%

100.0%

Chi-Square Tests


sided)

Pearson Chi-Square.204

a1 .651


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Surgery Outcome * Systemic Diagnosis Cross tabulation

Systemic

Diagnosis

Total

Absen

t

Presen

t

Surgery

Outcome

Succe

ss

79.5% 82.1% 80.0%

Failur

e

20.5% 17.9% 20.0%

Total100.0

%

100.0

%

100.0%

Chi-Square Tests


sided)

Pearson Chi-Square .294a

1 .588


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Discussion

The research has shown that the majority of patients are of the elderly

category which is understandable as cataract is a disease of mainly caused

by aging.

Patients ranging from 61-90 were the majority of the cases observed; they

made up 59% of the total number of cases presented at the hospital.

First discuss the outcome of cataract surgery, is it good compared to other

studies?

By running cross tabulation by chi square test, it was determined that age is

not associated with the outcome of the surgery and has no impact on the

results of the operation. This finding is similar to the previous researches.

The male to female ratio was 2.2:1 with 101 males (69.7%) and females at

44(30.3%) of the total 145 cases. However this is not to be taken as anindicator that males have a higher incidence of cataract than females do .

By running cross tabulation by chi square test, it was determined that

gender does not play any significant role on the outcome of the surgery.

86.2% of the cases were diagnosed as immature cataract while only a

minority of 13.8 were diagnosed as mature . This an indication of the very

slowly progressive nature of cataracts, and a long time in needed for the

disease to progress to mature cataract where the lens is completely

opacified.

Formatted: Highlight

Comment [a16]: Which research , wh


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There was a total of 12 cases with an associated disease accompanying the

cataract. 6 were retinal disease and the other 6 were glaucoma. By running

cross tabulation by chi square test, it was determined that associated

disease does not have a significant impact on the outcome of the surgery.

There were a total of 29 cases with systemic diseases, 17 of which were

Hypertension while the remaining 12 were diabetes. These diseases are

common among the elderly population and constituted 19.3% of the total

number of cases. By running cross tabulation by chi square test, it was

determined that the presence of systemic disease does not have a significant

impact on the outcome of the surgery.

There were four main types of surgery performed:-

Extra capsular cataract extraction (ECCE) Extra capsular cataract extraction + posterior chamber intraocular

lens (ECCE + PC IOL)

Phacoemulsification + posterior chamber intraocular (Phaco+ PCIOL)

Intracapsular cataract extraction + intraocular lens (ICCE + IOL)
https://en.wikipedia.org/wiki/Phacoemulsificationhttps://en.wikipedia.org/wiki/Phacoemulsification


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Phaco+ PC IOL was the most common performed making up 86.2% of all

the surgeries performed. It is the most common technique used in

developed countries.

The pre-operative visual acuities were recorded. 60% of the patients had

a visual acuity which was below 3/60, which is classified as blind by

the World Health Organization categories for visual impairment. 12.4%

were severely visually impaired, 19.3% were visually impaired and only

7.6% were among the normal range of visual acuity.

The post-operative visual acuities of the patients were recorded 1 day

after the operation in the follow up clinic and showed a vast

improvement. As the percentage of blind decreased to 20.7%, patients

with a normal visual acuity increased to 40.7%.

The visually impaired and severely visually impaired have also

increased in number but this can be attributed to the fact that the increase

is from patients who were blind before the operation and now have

moved to a these categories. Which overall, is considered a success.

80% of the surgeries performed were categorized as successful while

20% were categorized as a failure.

Comment [a17]:

Comment [a18]: Move this to the sta

discussion


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The determinants of success and failure in this research were that , any

improvement in the visual acuity of the patient after the surgery would

constitute a success , while if the visual acuity remained unchanged or

deteriorated , that would constitute a failure .

Better results and a more through approach could not be obtained due to

the fact that the patient records in the data base only included the visual

acuity 1 day post the operation and nothing more. Information on

changes to the visual acuity or any complications that might have taken

place over a longer period of time was not present.

Previous researches had longer follow-up periods and were able to

collect data on the patients for up to 5 years after the surgery had taken

place. They also used different methods of assessing the post-operative

results such as:-

satisfaction with vision self-reported trouble with vision and Sickness Impact Profile score


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Conclusion

The outcome of cataract surgery in Makkah Eye Hospital was that the

vast majority of the surgeries performed were successful and the

majority of the patients had their vision improved afterwards.

The visual acuities of all the patients were obtained pre-operatively and

post-operatively from the database.

Factors such as age, gender, ocular disease and systemic disease were

recorded in the patients and measured against the outcome of the

surgery.

It was determined that no significant association exists between those

factors and the outcome of cataract surgery .


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Recommendations

What are your recommendations regarding the cataract surgery itself?

The hospital keeps more organized online records as some of thepatient records had important missing data.

Follow- up of patients for a number of weeks after the operation.

More data on the patients be collected and entered into theirrecords in the online database. Example: infection before or after

the surgery, or any complications.

Different methods of assessment of visual acuity after theoperation such as patient satisfaction and self-reported trouble with

vision.

Spreading awareness about cataracts and its symptoms can help indiagnosis and treatment

Following the doctors instructions and showing up for thespecified follow-up dates will help in avoiding complications and a

more satisfactory end result


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References :

KHARTOUM COLLEGE OF MEDICAL SCIENCES

DEPARTMENT OF COMMUNITY MEDICINE

OUTCOME OF CATARACT SURGERY IN MAKKAH EYE

HOSPITAL

1. Age ( )

2. Gender: 1.male 2. Female

3. Type of Cataract? 1. Mature 2.Immature

4. Eye affected by cataract?

1. Left 2.right

5. Any associated diagnosis? Yes ( ) no ( )

6. If yes, specify

7. Systemic disease(s) with the cataract? Yes ( ) no ( )

8. If yes, specify

Comment [a19]: Add list of reference


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9. Type of surgery performed?

1.ECCE+PC IOL 2. PHACO+PC IOL 3.ICCE+IOL

10. Visual acuity before surgery: left eye ( ) right eye ( )

11. Visual acuity after surgery: left eye ( ) right eye ( )

References

1- Steinberg EP, Tielsch JM, Schein OD, Javitt JC, Sharkey P, Cassard SD, Legro MW, Diener-West M,

Bass EB, Damiano AM, et al. Johns Hopkins University School of Medicine, Baltimore, MD.

2- Department of Clinical Sciences, Ophthalmology (Lundstrm), Faculty of Medicine, Lund University,

Lund, Sweden; the Royal Victoria Eye and Ear and St. Vincent's University Hospital (Barry), Dublin,

[email protected].

3-University Eye Clinic, Frederiksberg Hospital, Copenhagen, Denmark. [email protected]

4-http://www.who.int/blindness/causes/priority/en/index1.html

5-Extracapsular Cataract Extraction - Definition, Purpose, Demographics, Description,

Diagnosis/preparation, Aftercare, Risks, Normal results, Morbidity and mortality rates, Alternatives

6-Charters, Linda Anticipation is key to managing intra-operative floppy iris syndrome. Ophthalmology

Times. June 15, 2006.

7-Categories of Visual Impairment in India

http://www.medindia.net/health_statistics/general/visualimpairment.asp#ixzz2SMF5g1JQ

8-Facts About Cataract : http://www.nei.nih.gov/health/cataract/cataract_facts.asp

9-Quillen DA (July 1999). "Common causes of vision loss in elderly patients". Am Fam Physician

10-"Posterior Supcapsular Cataract". Digital Reference of Ophthalmology. Edward S. Harkness Eye

Institute, Department of Ophthalmology of Columbia University. 2003.

11-Outcomes of small incision cataract surgery.

Uusitalo RJ, Tarkkanen A. Department of Ophthalmology, Helsinki University Central Hospital, Finland.

12-Outcomes of small incision cataract surgery.

Uusitalo RJ, Tarkkanen A. Department of Ophthalmology, Helsinki University Central Hospital, Finland.
http://www.ncbi.nlm.nih.gov/pubmed?term=Steinberg%20EP%5BAuthor%5D&cauthor=true&cauthor_uid=8008355http://www.ncbi.nlm.nih.gov/pubmed?term=Tielsch%20JM%5BAuthor%5D&cauthor=true&cauthor_uid=8008355http://www.ncbi.nlm.nih.gov/pubmed?term=Schein%20OD%5BAuthor%5D&cauthor=true&cauthor_uid=8008355http://www.ncbi.nlm.nih.gov/pubmed?term=Javitt%20JC%5BAuthor%5D&cauthor=true&cauthor_uid=8008355http://www.ncbi.nlm.nih.gov/pubmed?term=Sharkey%20P%5BAuthor%5D&cauthor=true&cauthor_uid=8008355http://www.ncbi.nlm.nih.gov/pubmed?term=Cassard%20SD%5BAuthor%5D&cauthor=true&cauthor_uid=8008355http://www.ncbi.nlm.nih.gov/pubmed?term=Legro%20MW%5BAuthor%5D&cauthor=true&cauthor_uid=8008355http://www.ncbi.nlm.nih.gov/pubmed?term=Diener-West%20M%5BAuthor%5D&cauthor=true&cauthor_uid=8008355http://www.ncbi.nlm.nih.gov/pubmed?term=Bass%20EB%5BAuthor%5D&cauthor=true&cauthor_uid=8008355http://www.ncbi.nlm.nih.gov/pubmed?term=Damiano%20AM%5BAuthor%5D&cauthor=true&cauthor_uid=8008355mailto:[email protected]:[email protected]://www.surgeryencyclopedia.com/Ce-Fi/Extracapsular-Cataract-Extraction.htmlhttp://www.surgeryencyclopedia.com/Ce-Fi/Extracapsular-Cataract-Extraction.htmlhttp://www.ophthalmologytimes.com/ophthalmologytimes/article/articleDetail.jsp?id=339794http://www.medindia.net/health_statistics/general/visualimpairment.asp#ixzz2SMF5g1JQhttp://www.aafp.org/afp/990700ap/99.htmlhttp://dro.hs.columbia.edu/lc1.htmhttp://www.ncbi.nlm.nih.gov/pubmed?term=Uusitalo%20RJ%5BAuthor%5D&cauthor=true&cauthor_uid=9530596http://www.ncbi.nlm.nih.gov/pubmed?term=Tarkkanen%20A%5BAuthor%5D&cauthor=true&cauthor_uid=9530596http://www.ncbi.nlm.nih.gov/pubmed?term=Uusitalo%20RJ%5BAuthor%5D&cauthor=true&cauthor_uid=9530596http://www.ncbi.nlm.nih.gov/pubmed?term=Tarkkanen%20A%5BAuthor%5D&cauthor=true&cauthor_uid=9530596http://www.ncbi.nlm.nih.gov/pubmed?term=Tarkkanen%20A%5BAuthor%5D&cauthor=true&cauthor_uid=9530596http://www.ncbi.nlm.nih.gov/pubmed?term=Uusitalo%20RJ%5BAuthor%5D&cauthor=true&cauthor_uid=9530596http://www.ncbi.nlm.nih.gov/pubmed?term=Tarkkanen%20A%5BAuthor%5D&cauthor=true&cauthor_uid=9530596http://www.ncbi.nlm.nih.gov/pubmed?term=Uusitalo%20RJ%5BAuthor%5D&cauthor=true&cauthor_uid=9530596http://dro.hs.columbia.edu/lc1.htmhttp://www.aafp.org/afp/990700ap/99.htmlhttp://www.medindia.net/health_statistics/general/visualimpairment.asp#ixzz2SMF5g1JQhttp://www.ophthalmologytimes.com/ophthalmologytimes/article/articleDetail.jsp?id=339794http://www.surgeryencyclopedia.com/Ce-Fi/Extracapsular-Cataract-Extraction.htmlhttp://www.surgeryencyclopedia.com/Ce-Fi/Extracapsular-Cataract-Extraction.htmlmailto:[email protected]:[email protected]://www.ncbi.nlm.nih.gov/pubmed?term=Damiano%20AM%5BAuthor%5D&cauthor=true&cauthor_uid=8008355http://www.ncbi.nlm.nih.gov/pubmed?term=Bass%20EB%5BAuthor%5D&cauthor=true&cauthor_uid=8008355http://www.ncbi.nlm.nih.gov/pubmed?term=Diener-West%20M%5BAuthor%5D&cauthor=true&cauthor_uid=8008355http://www.ncbi.nlm.nih.gov/pubmed?term=Legro%20MW%5BAuthor%5D&cauthor=true&cauthor_uid=8008355http://www.ncbi.nlm.nih.gov/pubmed?term=Cassard%20SD%5BAuthor%5D&cauthor=true&cauthor_uid=8008355http://www.ncbi.nlm.nih.gov/pubmed?term=Sharkey%20P%5BAuthor%5D&cauthor=true&cauthor_uid=8008355http://www.ncbi.nlm.nih.gov/pubmed?term=Javitt%20JC%5BAuthor%5D&cauthor=true&cauthor_uid=8008355http://www.ncbi.nlm.nih.gov/pubmed?term=Schein%20OD%5BAuthor%5D&cauthor=true&cauthor_uid=8008355http://www.ncbi.nlm.nih.gov/pubmed?term=Tielsch%20JM%5BAuthor%5D&cauthor=true&cauthor_uid=8008355http://www.ncbi.nlm.nih.gov/pubmed?term=Steinberg%20EP%5BAuthor%5D&cauthor=true&cauthor_uid=8008355


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13-Visual Acuity following Cataract Surgeries in Relation to Preoperative Appropriateness Ratings

http://hinari-gw.who.int/whalecommdm.sagepub.com/whalecom0/content/23/2/122.abstract

14 -Madan Mohan. National Survey of Blindness India:NPCB-WHO report 1989. New Delhi, All India Institutefor Medical Sciences, 1991.
http://hinari-gw.who.int/whalecommdm.sagepub.com/whalecom0/content/23/2/122.abstracthttp://hinari-gw.who.int/whalecommdm.sagepub.com/whalecom0/content/23/2/122.abstract

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Outcome of cataracts surgery.docx