Economic Constraints in Managing Complicated Cataracts

Abstract

Practicing in a low‑resource environment presents unusual challenges with the management of even the simplest conditions when physicians must choose between investigating their patients and proceeding to intervention with patients’ limited resources. Failure to perceive light, inaccurate light projection, or sonographic evidence of retinal detachment are all reasons to avoid cataract surgery, as there is no hope of visual recovery. However, when a patient already accepts a blind eye, but wants cataract surgery to remove the cosmetic blemish of leukocoria, they may question the necessity of preoperative ultrasonography because of the additional expense involved. Market forces can be defined as the economic factors affecting the price, demand, and availability of a commodity. In recent times, market forces have played increasingly significant role in the accessibility of standard healthcare in Nigeria; as Medical Services in Public Hospitals are no longer free, and the majority of Nigerians fund their healthcare through out‑of‑pocket expenditure, which places a burden on the economically challenged and uninsured. The main objective is to emphasize the importance of ultrasonography in a blind eye for the purpose of determining the position of a suspected retinal detachment, and to introduce the black occlusive intraocular lens (IOL). This is a report of cosmetic cataract surgery performed in a blind eye, with failure to achieve desired results, due to anteriorly displaced retinal detachment. This case describes the difficulties encountered with cosmetic cataract surgery in a low resource setting and discusses the use of occlusive IOL to improve cosmetic outcome. Cataract surgery is to be avoided in the presence of total retinal detachment. However, black occlusive IOL implantation may provide a cosmetically acceptable outcome.

Keywords: Cosmetic cataract extraction, leukocoria, occlusive intraocular lens, retinal detachment traumatic cataract