Outcomes of manual small-incision cataract surgery using standard 22 dioptre intraocular lenses at Nkhoma Eye Hospital, Malawi

Abstract

The aim of this study was to investigate the outcomes of sutureless, manual small-incision cataract surgery (SICS) in rural sub-Saharan Africa using standard intraocular lenses (IOLs). In order to assess the quality of surgery, we prospectively evaluated the visual outcomes of 1455 consecutive cataract operations performed in 2006 in patients ≥40 years at Nkhoma Eye Hospital, Malawi. All operations used standard 22-dioptre IOLs without pre-operative biometry. Outcomes were categorised according to the World Health Organization criteria, and causes of a poor outcome were recorded. Mean age of patients was 71.5 ± 9.5 years, and 53 % were female. Pre-operatively, 64 % of eyes had a visual acuity (VA) <6/60, and 41.3 % of eyes were blind (VA < 3/60). Without correction (uncorrected VA), nearly eighty percent (78.7 %) achieved a 'good' outcome (VA 6/6-6/18), 19.8 % were 'borderline' (VA < 6/18-6/60), and 1.5 % had a poor (VA < 6/60) outcome. With pinhole-correction, the proportion of good outcomes increased to 89.4 %, and poor outcomes decreased to 0.9 %. Poor outcomes were most commonly due to ocular co-morbidities (54.5 %) and refractive error (36.4 %). Older age and pre-operative blindness were strongly associated with borderline or poor visual outcomes. The most common surgical complication was posterior capsule tear (without vitreous loss). In a rural African environment, using standard IOL power plus SICS can lead to a high proportion of good outcomes and a low frequency of surgical complications. A comparative study is required to determine if any additional benefit in visual outcomes can be gained by the addition of biometry.

Blindness and visual impairment due to age-related cataract in sub-Saharan Africa: a systematic review of recent population-based studies

“…The proportion of good outcomes ranged from 23% to 70%, all of which fail to reach WHO target that ≥85% of eyes should achieve PVA<6/18 postoperatively. These proportion of good visual outcomes in most studies were markedly lower than from recent hospital-based studies on this continent 26 27. Prospective monitoring of outcomes can improve quality,28 with a dynamic and learning process for the surgeon of focusing on reducing surgical complications, greater emphasis on appropriate selection, need for spectacle correction and sequelae of surgery.…”

Assessment of astigmatism in manual and sutureless small incision cataract surgery

“…In this respect, they conducted a single-center prospective and descriptive study of 100 eyes. Other authors have conducted similar studies in developing countries [2,3,[5][6][7][8].…”

“…This technique allows to work in a self-sealing anterior chamber. The postoperative astigmatism is a complication of cataract surgery [5][6][7][8]. The authors wanted to assess astigmatism in this recent technique.…”

“…It is the surgical technique of cataract named sutureless and manual small incision cataract surgery (MSICS). It also gives good anatomical and functional results [2][3][4][5][6][7][8]. The purpose of this study was to assess the corneal astigmatism after cataract surgery by MSICS.…”

Task shifting for cataract surgery in eastern Africa: productivity and attrition of non-physician cataract surgeons in Kenya, Malawi and Tanzania

“…For individual countries, the known prevalence of vision loss due to cataract can be used to estimate the number of cataract operations (incident cases) needed to eliminate blindness or visual impairment due to cataract [2,3]. Achieving this level of productivity and improved quality of outcomes [4] would eliminate blindness due to cataract [5] and result in achievement of the International Agency for the Prevention of Blindness, VISION 2020 goals.…”