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Sep 15, 2005Keywords:
cataract outcome Ecce-pciol complications one-year follow-up
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Assesment of one-year follow up of patients with Ecce-pciol surgery at University of Ilorin teaching hospital, Kwara State, Nigeria
Abstract
Objectives:
1. To assess the visual outcome and complications during a one-year follow-up period of all patients who had extracapsular cataract extraction (ECCE) with posterior chamber intraocular lens PCIOL implant.
2. To assess the average intraocular lens (IOL) power required to achieve emmetropia before the availability of the keratometer and A-Scan ultrasound machine in our centre. Materials and methods: All cases of ECCE-PCIOL done at the University of Ilorin Teaching Hospital, over a period of eighteen months (Jan 2001-July 2002) were included in the study. Visual acuity, ocular status and complications for each patient were assessed before the surgery and also at regular periods during the one-year follow-up.
Results: A total of 105 patients (116 eyes) were operated. Eleven patients (9.4%) had bilateral surgery. The patients age range was 7-89 years with a mean of 64 years and a male to female ratio of 1:1.2. Sixty-six (57%) patients had right eye (RE) surgery, while 50 (43%) had left eye (LE) surgery; 98% of them had a preoperative visual acuity of <3/60 in the operated eye. The types of cataract seen were: senile 81.0%, presenile 11.2%, congenital (for secondary implant) 1.7%, post traumatic 2.5%, and post uveitic 1.7%. Five eyes (4.2%) with phacomorphic glaucoma were omitted during the analysis. At discharge, 9.1% of the patients had VA of 6/6-6/18 unaided, while 73.8% had VA of 6/24-3/60; 17.1% remained blind with a VA of <3/60. At one month follow-up, 33.7% had VA of 6/6-6/18 while 62.1% had VA of 6/24-3/60, and 4.2% remained blind with a VA of <3/60. Ninety-five of the patients (86.4%) came for follow-up assessment. During assessment at two months with refraction, 83.8% had VA of 6/6-6/18; 13.2% had 6/24-3/60 VA and 2.9% remained blind. A total of [1] 68 patients (61.3%) came for this second follow-up. At the 6 month follow-up, -77.3% had VA of 6/6-6/18, while 22.6% had VA of 6/24-3/60. Thus 100% had VA[2] >3/60. Only 54 patients (49%) showed up for this follow-up assessment. VA at one year: 78.7% had VA of 6/6-6/18, and 10.74% had VA of 6/24-3/60. About 10% [3] had become blind with VA <3/60, mainly from posterior capsular opacity. Only 47 of the patients (42.7%) came for this follow-up assessment. Peri-operative complications included: pupillary distortion 26.1%), striae keratopathy (23.4%), residual cortical matter (13.5%), and posterior capsular rent (6.3%). Wound dehiscence, raised IOP, lens dislocation, and corneal oedema had between 1.5-2.5% occurrence. Complications at one year: pupillary distortion (31.1%), posterior capsular opacity generally (23%), but 10.3% had posterior capsular opacity dense enough to give VA <3/60, 2.1% of the patients had persistent corneal oedema and another 2.1% developed pupillary membrane. The average IOL power likely to give emmetropia in an adult in situations where it is not possible to calculate IOL power is 20 diopters, as shown by the assessment of the outcome of refraction and the IOL power used. In conclusion, cataract surgery by ECCE-PCIOL implant is a safe and rewarding method of cataract surgery even in a developing nation like Nigeria. The complications are amenable to correction where facilities are available. Outcome can be improved when basic requirements like A Scan, keratometry, and YAG laser are available. The absence of any case of endophthalmitis is also worthy of note.
Key words: cataract, outcome, Ecce-pciol, complications, one-year, follow-up
Nigerian Journal of Ophthalmology Vol 12(2) 2004: 65-69
1. To assess the visual outcome and complications during a one-year follow-up period of all patients who had extracapsular cataract extraction (ECCE) with posterior chamber intraocular lens PCIOL implant.
2. To assess the average intraocular lens (IOL) power required to achieve emmetropia before the availability of the keratometer and A-Scan ultrasound machine in our centre. Materials and methods: All cases of ECCE-PCIOL done at the University of Ilorin Teaching Hospital, over a period of eighteen months (Jan 2001-July 2002) were included in the study. Visual acuity, ocular status and complications for each patient were assessed before the surgery and also at regular periods during the one-year follow-up.
Results: A total of 105 patients (116 eyes) were operated. Eleven patients (9.4%) had bilateral surgery. The patients age range was 7-89 years with a mean of 64 years and a male to female ratio of 1:1.2. Sixty-six (57%) patients had right eye (RE) surgery, while 50 (43%) had left eye (LE) surgery; 98% of them had a preoperative visual acuity of <3/60 in the operated eye. The types of cataract seen were: senile 81.0%, presenile 11.2%, congenital (for secondary implant) 1.7%, post traumatic 2.5%, and post uveitic 1.7%. Five eyes (4.2%) with phacomorphic glaucoma were omitted during the analysis. At discharge, 9.1% of the patients had VA of 6/6-6/18 unaided, while 73.8% had VA of 6/24-3/60; 17.1% remained blind with a VA of <3/60. At one month follow-up, 33.7% had VA of 6/6-6/18 while 62.1% had VA of 6/24-3/60, and 4.2% remained blind with a VA of <3/60. Ninety-five of the patients (86.4%) came for follow-up assessment. During assessment at two months with refraction, 83.8% had VA of 6/6-6/18; 13.2% had 6/24-3/60 VA and 2.9% remained blind. A total of [1] 68 patients (61.3%) came for this second follow-up. At the 6 month follow-up, -77.3% had VA of 6/6-6/18, while 22.6% had VA of 6/24-3/60. Thus 100% had VA[2] >3/60. Only 54 patients (49%) showed up for this follow-up assessment. VA at one year: 78.7% had VA of 6/6-6/18, and 10.74% had VA of 6/24-3/60. About 10% [3] had become blind with VA <3/60, mainly from posterior capsular opacity. Only 47 of the patients (42.7%) came for this follow-up assessment. Peri-operative complications included: pupillary distortion 26.1%), striae keratopathy (23.4%), residual cortical matter (13.5%), and posterior capsular rent (6.3%). Wound dehiscence, raised IOP, lens dislocation, and corneal oedema had between 1.5-2.5% occurrence. Complications at one year: pupillary distortion (31.1%), posterior capsular opacity generally (23%), but 10.3% had posterior capsular opacity dense enough to give VA <3/60, 2.1% of the patients had persistent corneal oedema and another 2.1% developed pupillary membrane. The average IOL power likely to give emmetropia in an adult in situations where it is not possible to calculate IOL power is 20 diopters, as shown by the assessment of the outcome of refraction and the IOL power used. In conclusion, cataract surgery by ECCE-PCIOL implant is a safe and rewarding method of cataract surgery even in a developing nation like Nigeria. The complications are amenable to correction where facilities are available. Outcome can be improved when basic requirements like A Scan, keratometry, and YAG laser are available. The absence of any case of endophthalmitis is also worthy of note.
Key words: cataract, outcome, Ecce-pciol, complications, one-year, follow-up
Nigerian Journal of Ophthalmology Vol 12(2) 2004: 65-69
