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A questionnaire regarding the working practices and incidence of back pain was sent to all 498 consultant ophthalmologists in the United Kingdom. Three hundred and twenty-five (65.3%) questionnaires were analysed by time spent in speciality, and time spent operating each week. One hundred and seventy-four ophthalmologists (54%) had significant attacks of back pain, with the longest-serving consultants having an increased incidence. The number and duration of acute attacks increased with years in speciality but was unrelated to time spent operating. Treatment included analgesics in 97 (56%), physiotherapy in 40 (23%), and 'alternative' medical treatment including osteopathy and chiropraxy in 14 (8%); no treatment was needed in 56 (32%). Investigation and treatment increased with years spent in speciality, 49 (28%) seeking medical advice, usually from a specialist, and 69 (39%) requiring further investigations including plain radiographs, CT scans, myelograms and MRI scans. Nine surgeons needed surgery for back pain.

Aim-To evaluate the results of cataract surgery performed in a rural Indian eye camp. Method-The pre-and postoperative visual acuities and surgical complications were recorded prospectively in 6383 eyes undergoing cataract extraction for age related cataract in rural eye camps held in northern India in 1993-4. The best visual acuity and cause of poor outcome were recorded on 3908 eyes seen at 6 weeks' follow up. Results-Of 6383 operated eyes 94.8% had a visual acuity of less than 3/60 preoperatively, and 41% of the procedures were performed on patients who were bilaterally blind (less than 3/60 better eye). At discharge with standard aphakic spherical spectacles, 11.3% of eyes had an acuity of less than 6/60 (poor outcome), and 25.9% had an acuity of 6/18 or better. At 6 weeks' follow up 3908 eyes were examined (61.2%), of which, with best correction, 4.3% had poor outcome (acuity of less than 6/60) and 79.9% obtained 6/18 or better. Pre-existing eye pathology was responsible for poor outcome in 3.0% of eyes and surgical complications in 1.3% of eyes, of which corneal decompensation was the major cause (0.5%). In 237 eyes which received an intraocular lens implantation (IOL) in the camp, the visual acuity at discharge was 6/18 or better in 44.5% of eyes improving to 87.9% in the 157 eyes which were seen at 6 weeks' follow up. Poor outcome (less than 6/60) was seen in 5.7% of the eyes with an IOL at discharge improving to 1.9% at follow up. Conclusion-This evaluation suggests that it is possible to obtain acceptable results from cataract extraction with experienced ophthalmologists in well conducted Indian eye camps. Better correction of aphakia at discharge from the camp would improve the immediate visual results, which is important as a significant number of patients do not return for follow up. The use of posterior chamber IOLs in the eye camp by experienced ophthalmologists, appeared to give satisfactory results, although further evaluation with a larger series of cases and more surgeons is required before it can be recommended. (Br J Ophthalmol 1999;83:343-346) Worldwide there are estimated to be approximately 45 million blind people with a visual acuity less than 3/60 in the better eye. At least 80% of these people live in developing countries, and more than half are blind as a result of cataract.

SUMMARYThere has been recent interest in the progression of diabetic retinopathy following extracapsnlar cataract extraction (ECCE) especially with vitreous loss. It is well known that diabetic retinopathy progresses after intracapsular cataract extraction (ICCE) but was thought to be less common after ECCE. We present 7 patients with symmetrical non-proliferative diabetic retinopathy who underwent ECCE with intraocular lens (IOL) implantation. These patients ranged in age from 56 to 69 years; 2 were insulin-dependent diabetics (100M) and 5 non-lOOMs. There have been reports of complications of cataract surgery in diabetics, and of progression of diabetic retinopathy following cataract surgery over a prolonged time period compared with the fellow eye which initially had a similar level of retino pathy. l , 2 Recently two cases have been reported of rapid progression of retinopathy in the immediate post-operative period with rubeosis developing within a few weeks of surgery in the operated eye only. 3 We present 7 cases of diabetics who progressed to aggressive neovascularisation or rubeosis leading to rubeotic glaucoma and severe visual loss within a few weeks of surgery. These patients were managed by general ophthalmologists in centres where there were no consultants with an interest in diabetes (except one), and nor were these patients referred to a recognised diabetic specialist when complications arose. CASE REPORTS Case 1A 65-year-old West Indian man with a 26 year history of non-insulin-dependent diabetes mellitus (non-IDDM) presented in August 1989 with a right visual acuity (VA) of 6/36 and a left VA of 6/60. He was found to have bilateral posterior subcapsular and cortical cataracts. Fundal examination revealed exudates at the right macula, and two incomplete circinate rings around the left macula. There were no new vessels (NV) in either eye. Focal laser was not performed for the left circinate rings as it was felt that the fundal view was inadequate.He underwent an uncomplicated left extracapsular cataract extraction (ECCE) with intraocular lens implantation (IOL) in November 1989. Four months post-operatively his V A was 6/60 in the right eye and 6/18 in the left with new spectacles. The intraocular pressure (lOP) was 20 mmHg in each eye. Fundal Eye (1995) 9, 728-732

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