Visual outcomes of high-volume compared with low-volume manual small-incision cataract surgery in Nepal

Abstract

Purpose: To study whether manual small-incision cataract surgery (MSICS) in a high-volume setting gives acceptable postoperative visual outcomes. Settings: Geta Eye Hospital, Kailali, Nepal. Design: Single-center retrospective study. Methods: One-year records of all MSICS in adult patients without any other ocular comorbidity were analyzed retrospectively. Surgical outcomes of cataract cases when surgeons performed more than 72 surgeries (high volume) in a single operating session (1 day) were compared with when fewer than 30 surgeries (low volume) were performed in a single operating session (1 day). Results: Of 23 717 cases in the study, 20 574 patients (87%) had preoperative visual acuity of less than 3/60; 15 632 patients (66%) achieved good visual outcome (uncorrected distance visual acuity of 6/18 or better) postoperatively. Patients operated during high-volume months achieved good visual outcomes in 9930 cases (66.9%) as compared with 5702 (64.3%) in low-volume months. However, 6235 patients (61.7%) operated on during high-volume days had good visual outcomes as compared with 3053 (71.4%) during low-volume days; 175 patients in the high-volume group and 73 patients in the low-volume group (1.7% each) achieved visual acuity worse than 3/60. There were comparable posterior capsular rupture rates (423 [1.78%]) during high- and low-volume months, and 21 cases (0.09%) of postoperative endophthalmitis were noted. Conclusions: MSICS can be used to reduce large cataract backlogs in developing countries as good visual outcomes could be achieved in high-volume settings if standard protocols for quality control are followed.

Prevalence and causes of blindness and visual impairment in Sudur paschim Province of Nepal

“…These protocols have also been able to provide high quality outcomes, helping to decrease the prevalence of blindness and visual improvement in the province. [25, 28]…”

“…These protocols have also been able to provide high quality outcomes, helping to decrease the prevalence of blindness and visual improvement in the province. [25,28] Despite this progress, cataract is still the main cause of blindness (36.4%) followed by non trachomatous corneal opacity (24.2%), glaucoma (21.2%), all other globe or CNS abnormality (9.1%), ARMD (6.1%), other posterior segment disease (3%). Again, cataract is the main cause in SVI (85.7%) and MVI (55.1%) category.…”

“…These protocols have also been able to provide high quality outcomes, helping to decrease the prevalence of blindness and visual improvement in the province. [25,28] . CC-BY 4.0 International license It is made available under a is the author/funder, who has granted medRxiv a license to display the preprint in perpetuity.…”

A National Survey of Endophthalmitis Prophylaxis during Cataract Surgery in Pakistan: A 2020 Perspective

“…Studies have shown postoperative endophthalmitis rates with MSICS are comparable to high-income countries using phacoemulsification. 20 The technical skills of an ophthalmic surgeon is another important factor in considering postoperative cataract surgery outcomes. A large cohort study observed that newly-qualified surgeons undertaking independent practice were 9 times more likely to have high complication rates (greater than 2%), including endophthalmitis, when compared to surgeons in their tenth year of practice.…”

“…Diminishing returns and statistically insignificant differences are seen beyond these arbitrary values otherwise. 20 Clinical audits are a method of ensuring that healthcare is provided in line with set standards. It allows care providers, as well as patients, know if a service is performing well, or if improvements can be made.…”