Can phaco be a cost-effective solution to cataract blindness? Costs and outcomes in Nepal

Hennig, Albrecht; Singh, Sanjay Kumar; Winter, I; Yorston, David

doi:10.1038/eye.2009.241

Cited by 7 publications

(13 citation statements)

References 1 publication

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…2 We agree with Dr Tan that a small increase in unit cost can add up to a large increase in total cost in a high-volume setting. However, this must be set against the improved visual outcomes.…”

mentioning

confidence: 55%

Response to Dr Colin Tan

Hennig¹,

Singh

Winter

et al. 2010

Eye

Self Cite

View full text Add to dashboard Cite

show abstract

mentioning

confidence: 55%

Response to Dr Colin Tan

Hennig¹,

Singh

Winter

et al. 2010

Eye

Self Cite

View full text Add to dashboard Cite

show abstract

“…Treatment includes drug withdrawal and control of bleeding. 2 We believe this is the first reported case of quinine-induced thrombocytopenia associated with intraocular haemorrhage.…”

Section: Commentmentioning

confidence: 92%

“…Treatment includes drug withdrawal and control of bleeding. 2 We believe this is the first reported case of quinine-induced thrombocytopenia associated with intraocular haemorrhage.Awareness of quinine use in the elderly population is important. The Royal College of Ophthalmologists local anaesthetic guidelines suggest a pre-operative FBC only for patients with a history of systemic disease or abnormal examination.…”

mentioning

confidence: 92%

Cost effectiveness of phacoemulsification in developing countries

Tan

2010

Eye

View full text Add to dashboard Cite

The following day, the visual acuity was hand movements. Fundus and ultrasound examination ( Figure 1a) confirmed extensive suprachoroidal haemorrhage. A full blood count (FBC) showed thrombocytopenia (platelet count 87 Â 10 9 /l). Haematology opinion was sought; investigations including a blood film and autoimmune screen were normal. Quinine was stopped and the platelet count has gradually risen. With conservative management, the left visual acuity has improved to 6/6 at 4 months post-surgery despite the presence of macular choroidal folds (Figures 1b and c). CommentExpulsive suprachoroidal haemorrhage is a rare but potentially devastating event during intraocular surgery. Occult thrombocytopenia is the only identifiable risk factor for haemorrhage in this patient. Extensive haematological investigation has strongly suggested quinine drug-induced immune thrombocytopenia (DITP). The rise in platelet count since cessation of quinine supports this.Quinine causes DITP by stimulating production of antibodies against platelet membrane glycoproteins causing platelet destruction. Treatment includes drug withdrawal and control of bleeding. 2 We believe this is the first reported case of quinine-induced thrombocytopenia associated with intraocular haemorrhage.Awareness of quinine use in the elderly population is important. The Royal College of Ophthalmologists local anaesthetic guidelines suggest a pre-operative FBC only for patients with a history of systemic disease or abnormal examination. 3 We feel that occult thrombocytopenia significantly contributed to the suprachoroidal haemorrhage in this case and recommend an FBC prior to intraocular surgery for all patients taking quinine.

show abstract

“…13 A separate study book for each participant was prepared including a photo, detailed address and separate pages for data on recruitment, surgery, discharge, and 6-week and 1-year follow-up. Computer data entry was done by two different persons, then validated by a third person for corrections.…”

Section: Methodsmentioning

confidence: 99%

“…12 This study arose from the clinical observation that implanting an inexpensive rigid IOL after phacoemulsification appeared to give visual outcomes comparable to more expensive foldable IOLs. 13 We designed this randomised controlled trial in order to make a fair comparison between the two types of IOL following phacoemulsification. The rationale for the study is that, if an inexpensive rigid IOL is as safe and effective as a foldable IOL, phaco could be accessible to patients in LMICs who currently cannot afford a foldable IOL.…”

Section: Introductionmentioning

confidence: 99%

Foldable vs rigid lenses after phacoemulsification for cataract surgery: a randomised controlled trial

Hennig¹,

Puri²,

Sharma³

et al. 2014

Eye

Self Cite

View full text Add to dashboard Cite

Purpose To compare the outcomes of phacoemulsification with either a 2.5-mm clear corneal incision and a foldable intraocular lens (IOL) or a 5-mm sclerocorneal tunnel incision and a rigid polymethyl methacrylate (PMMA) IOL. Methods In a prospective, randomised clinical trial of phacoemulsification cataract surgery, 1200 patients received either a foldable hydrophilic acrylic IOL through a 2.5-mm corneal incision or an inexpensive rigid PMMA IOL via a 5-mm sclerocorneal tunnel. Intra-and post-operative data and visual acuity at discharge, 6 weeks, and 1 year follow-up were analysed.Results At 1 year after surgery, 996 (83.0%) patients were followed up with an uncorrected visual acuity of 6/18 or better in 90.3% of the foldable and 94.3% in the rigid IOL group (risk ratio (RR) 0.96, 95% confidence intervals (CI) 0.92-0.99). Poor outcome (best-corrected acuity 6/60 or worse) occurred in 1.0% and 0.4%, respectively (RR 4.28,). The surgical cost of consumables and overall surgical time were similar in both groups; however, the cost of the foldable IOL was eight times higher than the PMMA IOL. Posterior capsule opacification was more common in the rigid IOL group at 12 months (36.1% vs 23.3%); however, this did not affect postoperative vision. Conclusion In the hands of experienced cataract surgeons, phacoemulsification with implantation of a foldable or a rigid IOL gives excellent results. Using an inexpensive rigid PMMA IOL will make phacoemulsification more affordable for poor patients in low-and middle-income countries.

show abstract

Can phaco be a cost-effective solution to cataract blindness? Costs and outcomes in Nepal

Cited by 7 publications

References 1 publication

Response to Dr Colin Tan

Response to Dr Colin Tan

Cost effectiveness of phacoemulsification in developing countries

Foldable vs rigid lenses after phacoemulsification for cataract surgery: a randomised controlled trial

Contact Info

Product

Resources

About