AN AUDIT OF PHACOEMULSIFICATION CATARACT SURGERY OUTCOME AT MENILIK II

REFERAL HOSPITAL AND BIRUH VISION SPECIALIZED EYE CLINIC, ADDIS ABABA,
ETHIOPIA.

Yonas Abraham1, Yonas Tilahun2 ,

1 Ophthalmology Resident, Addis Ababa University, Department of Ophthalmology

2 Associate Professor of Ophthalmology, Addis Ababa University, Department of

Ophthalmology
 

1 04/03/2021
 
CONFLICTS OF INTEREST

 I have no actual or potential conflict of interest in relation to this

program/presentation.
BACKGROUND

 Globally the number of people of all ages visually impaired is estimated to be

285 million, of whom 39 million are blind. Cataract accounts for 51% of the
blindness and 33% of visual impairment [1].

 WHO recommended and set targets [2]:

uncorrected visual acuity- Good> 80% of surgeries & poor < 5%

 corrected visual acuity – Good> 90% of surgeries & poor <5%

 The main issue in Phacoemulsification cataract surgery is its minimal use in

low income countries because of the cost but has its benefits [3,4].

 Performing surgical audit is one of the methods of quality control [5].

 AIM OF THE STUDY

 To assess Visual Outcome of Phacoemulsification cataract

surgery.

 To assess intraoperative and postoperative complication of

Phacoemulsification surgery.

 To determine causes of poor outcome (4S’s)

 
 SUBJECTS AND METHODS

 A Multicenter prospective interventional study was conducted between Feb

2017- Mar 2018 G.C. on patients who underwent Phacoemulsification surgery
under 3 different Experienced Surgeons at Menilik II referral Hospital and
Biruh vision specialized eye clinic.

 All patients who underwent Phacoemulsification surgery in these two centers

except those who had Ocular co-morbidity that would affect Visual Outcome
or with poor visual prognosis were excluded.

 For Consenting Patients detailed Structured Questionnaire was administered

& Full Ocular Examination was done.

 Data was extracted, entered and analyzed using IBM® SPSS® Statistics, version
21 for Windows.
 RESULTS
 262 eyes of 240 patients
 23 and 82 years with mean 60.79 ±10.5 years
 145 (60.4%) were males. M:F 1:1.52.

Bar Chart: Age and gender distribution of the patients who underwent Phacoemulsification
Menilik II Referral Hospital & Biruh Vision Specialized Eye Clinic, Feb. 2017 – Mar. 2018
70

60

50

40

Male (60.4%)
30
Female (39.6%)

20

10

0
<30 30-40 41-50 51-60 61-70 71-80
 The most common placement of IOL was in the capsular bag 251 (95.8%) of
cases followed by Sulcus 8 (3.1%) and Anterior Chamber 3 (1.1%).

 Of those Operated, 12 eyes had Co-Morbidity but none had poor outcome
which was statistically significant (p=<0.001).

 PSC was the Commonest type with 49.6% followed by Cortical at 17.6%.
 Table 1: Distribution of visual acuity among patients in the pre and post-
operatively periods
Menilik II Referral Hospital & Biruh Vision Specialized Eye Clinic, Feb. 2017 –
Mar. 2018

6/6-6/18 6/24-6/60 <6/60 Total

Pre-Op VA 62 105 95 262

1st POW 237 18 7 262

4th /6th POW 246 (93.9%) 11 (4.2%) 5 (1.9%) 262

UCVA
4th /6th POW 254 (96.9%) 6 (2.3%) 2 (0.8%) 262
BCVA
 The overall intra-op complication rate was 16 (6.1%) of which PCT with vitreous
loss 9 (3.4%) was the commonest. (Pie Chart)

Pie Chart: Intra-operative Complications Rates

Menilik II Referral Hospital & Biruh Vision Specialized Eye Clinic, Feb. 2017 – Mar. 2018

Intra-op complications

PCT with Vitreous loss - 3.4% PCT only - 2.3%

Zonular Dehiscence - 0.4%
 In the post-op period complication rate was around 4.18% (n=11). PCO (1.14%) was the
commonest Complication seen. (Table 2)

 Of the 6 with borderline outcome only 1 had post-operative complications (PCO). All (2) eyes
with poor outcome had post-op complication (PBK) was statistically significant (p<0.001).

Table 2: Post-operative complication Rates

Menilik II Referral Hospital & Biruh Vision Specialized Eye Clinic, Feb. 2017 – Mar. 2018
Complications Number (%)
Retained Cortex 1 (0.38%)

Lens dislocation 1 (0.38%)

PCO 3 (1.14%)
Pupillary Block 1 (0.38%)

Hyphema 1 (0.38%)
CME 1 (0.38%)
RD 1 (0.38%)
PBK 2 (0.72%)
Total 11(4.18%)
 Table 3 Association between Final BCVA & Post-op Complication
Menilik II Referral Hospital & Biruh Vision Specialized Eye Clinic, Feb. 2017 –
Mar. 2018
Post-op Comp Post-op BCVA (6TH POW) P- Value Total (%)

6/6-6/18 6/18-6/60 <6/60

No 247 5 0 <0.001 252

Retained 1 0 0 1
Cortex
Lens 1 0 0 1
dislocation
PCO 2 1 0 3

Pupillary Block 1 0 0 1

Hyphema 1 0 0 1

CME 1 0 0 1

PBK 0 0 2 2

Total 254 6 2 262

o None of the patients with Spectacle correction had Poor Outcome. (P = 0.034).
After Refraction in the 4/6th POW results were as follows:

 Sphere -0.5 - +2.00

 Cylinder -2.50 – 0.00

 Of the 16 Patients with Intra-op complications : 15 had Good , 1 had Borderline

& None had Poor Outcome. ( P=0.938)
DISCUSSIONS

 The UCVA outcome was superior to that of done by Ventakesh [6] But BCVA
was similar to the same study as well as that by Lundstrom [7].

 Intra-op complication rates were better than Kim BZ et al [8], comparable to

that of Shyalle K [9] & Less than Ventakesh [6], Aravind [10] & UK [11].

 Post-op Complication rates were better than Kim BZ [8], Comparable to UK

[11] & less in Nepal [12].
CONCLUSIONS

 Overall Visual Outcome & Complication rates are well within the
acceptable parameters set by WHO.

 Intra-op & Post-op Complication rates were relatively low.

 

 The factor contributing to poor outcome was related to surgery.

 
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