Role of small incision cataract surgery in the Indian scenario

Thomas, Ravi

doi:10.4103/0301-4738.44485

Cited by 26 publications

(26 citation statements)

References 4 publications

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“…[2223] The proliferation of fellowships in phacoemulsification is testimony to the lack of instruction in modern techniques of cataract surgery during residency. In this setting, teaching of glaucoma diagnosis, let alone surgery, is almost nonexistent.…”

Section: Residency and Glaucoma Training In Developing Countriesmentioning

confidence: 99%

Glaucoma in developing countries

Thomas

2012

Indian J Ophthalmol

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Objective:To describe the background and strategy required for the prevention of blindness from glaucoma in developing countries.Materials and Methods:Extrapolation of existing data and experience in eye care delivery and teaching models in an unequally developed country (India) are used to make recommendations.Results:Parameters like population attributable risk percentage indicate that glaucoma is a public health problem but lack of simple diagnostic techniques and therapeutic interventions are barriers to any effective plan. Case detection rather than population-based screening is the recommended strategy for detection. Population awareness of the disease is low and most patients attending eye clinics do not receive a routine comprehensive eye examination that is required to detect glaucoma (and other potentially blinding eye diseases). Such a routine is not taught or practiced by the majority of training institutions either. Angle closure can be detected clinically and relatively simple interventions (including well performed cataract surgery) can prevent blindness from this condition. The strategy for open angle glaucoma should focus on those with established functional loss. Outcomes of this proposed strategy are not yet available.Conclusions:Glaucoma cannot be managed in isolation. The objective should be to detect and manage all potential causes of blindness and prevention of blindness from glaucoma should be integrated into existing programs. The original pyramidal model of eye care delivery incorporates this principle and provides an initial starting point. The routine of comprehensive eye examination in every clinic and its teaching (and use) in residency programs is mandatory for the detection and management of potentially preventable blinding pathology from any cause, including glaucoma. Programs for detection of glaucoma should not be initiated unless adequate facilities for diagnosis and surgical intervention are in place and their monitoring requires reporting of functional outcomes rather than number of operations performed.

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Section: Residency and Glaucoma Training In Developing Countriesmentioning

confidence: 99%

Glaucoma in developing countries

Thomas

2012

Indian J Ophthalmol

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“…If local patients are used for teaching purposes (whether of local staff or visitors), the level or supervision must be high, using appropriate instrumentation such as beam splitters, observer scopes, and modern management of any complications such as vitreous loss. 6 Being aware of some of these potential issues is an important precondition to change and development. As for how to then deal with them, we do not have a simple answer, but can testify that the blunt, but honest approach is rarely well received.…”

Section: Ophthalmic Support In Developing Countriesmentioning

confidence: 99%

Ophthalmic support in developing countries

Thomas

Lawlor

2013

Clinical Exper Ophthalmology

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operators. We note, however, that our ACE-L IOP data are comparable with Tonolab IOP measurement in unanaesthetized and unsedated C57BL/6J male mice (range 13.3 ± 0.3). 3 In summary, acepromazine provided enough sedation to allow relatively easy steady-state mouse IOP measurement over at least 1 h without concern of significant druginduced IOP variation unlike KAX-anaesthetized mice. This finding under acepromazine was replicated using two dosages having different sedation levels, with steady-state IOP measurable over a long period between 30 and 105 min after acepromazine administration. It should be noted, however, that greater sedation was associated with lower IOP. These findings are important to note when choosing anaesthesia/sedation and measurement time points to capture live mouse IOP.

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“…We do use viscoelastic for some stages of this surgery, but if costs are a consideration the entire operation can be performed without any viscoelastic and a secure sutureless incision is achieved 98% of the time . The wound does not leak even with pressure on the posterior edge, and the anterior chamber maintainer crucial to the technique ensures a fluid egress system much like with vitrectomy; both – in theory – protect against endophthalmitis . Likewise, lack of detrimental effect on the endothelium has been reported for the Blumenthal and the visco‐expression, and cannot be extrapolated to all MSICS …”

mentioning

confidence: 99%