|Year : 2015 | Volume
| Issue : 3 | Page : 99-102
Comparison of visual outcome between conventional extracapsular cataract extraction and phacoemulsification cataract surgery
Department of Ophthalmology, College of Health Sciences, Bayero University, Kano, Kano State, Nigeria
|Date of Web Publication||27-Oct-2015|
Department of Ophthalmology, College of Health Sciences, PMB 3011, Kano, Kano State
Source of Support: None, Conflict of Interest: None
Objectives: To compare visual outcomes in patients who had conventional extracapsular cataract extraction (ECCE) and phacoemulsification for age-related cataract.Materials and Methods: Prospective study comparing the visual outcomes in 360 eyes of 352 patients, 180 of whom were randomized to conventional ECCE and the remaining 180 to phacoemulsification cataract surgery. Visual acuity was assessed on day 1, 1 week, 4 weeks, and 12 weeks postoperatively.Results: In the EECE group, good presenting visual acuity of 6/18 or even better was found in 6%, 31%, 46%, and 69% patients at 1-day, 1-week, 4-week, and 12-week postoperative intervals, respectively. In the phacoemulsification group, visual acuity of 6/18 or even better was achieved in 48%, 78%, 82%, and 89% patients, respectively, at the same postoperative interval as the ECCE group. This difference was statistically significant at all the postoperative intervals.Conclusion: Phacoemulsification achieves better postoperative visual acuity at the early and intermediate postoperative periods. Availability of this technique of cataract extraction will enhance eye care in our various institutions.
Keywords: Conventional extracapsular cataract extraction, phacoemulsification, visual outcome
|How to cite this article:|
Abdulsalam S. Comparison of visual outcome between conventional extracapsular cataract extraction and phacoemulsification cataract surgery. J Health Res Rev 2015;2:99-102
|How to cite this URL:|
Abdulsalam S. Comparison of visual outcome between conventional extracapsular cataract extraction and phacoemulsification cataract surgery. J Health Res Rev [serial online] 2015 [cited 2019 Dec 8];2:99-102. Available from: http://www.jhrr.org/text.asp?2015/2/3/99/168365
| Introduction|| |
The World Health Organization (WHO) estimated that 20 million people are blind from cataract worldwide, making it the leading cause of visual loss. By the year 2020, the projected number of persons with blinding cataract will exceed 40 million worldwide.
In Nigeria, the National Blindness and Low Vision Survey carried out between January 2005 and June 2007 reported that 42.9% of blindness was due to cataract.
In developing countries, the economic impact of visual loss from cataract is huge including loss of job and increase in custodial care. It has been estimated that 1500% of the cost of cataract surgery could be generated in 1 year through increased productivity that results from restoration of vision following cataract surgery in patients blinded by cataract.
In the developing world that includes Nigeria, the technique of phacoemulsification is not very common mainly due to the high cost of procurement and maintenance of the equipment. This procedure is now available in a few of the centers in the country and hence, its comparison was carried out with conventional extracapsular cataract extraction (ECCE) that is the most commonly performed procedure for cataract surgery.
| Materials and Methods|| |
The study was carried out on 360 eyes of 352 patients, 180 of whom were randomized to conventional ECCE and 180 to phacoemulsification between October 2011 and August 2012 at Makkah Specialist Eye Hospital, Kano, Kano State, Nigeria. Inclusion criteria were patients aged 40 years and above with age-related cataract with no ocular comorbidity. All patients had biometry using a Contruzione Strumenti Oftalmici (CSO) Javal Schiotz 2 position karatometer (Italy) for keratometry and an ocuScan A-scan for axial length measurement. The intraocular lens power was calculated using the Sanders-Retzlaff-Kraff (SRK) II formula.
Patients were required to sign a written consent agreeing to participate in the study. The conventional ECCE group had rigid polymethyl methacrylate (PMMA) posterior chamber intraocular lens while the phacoemulsification group had foldable poly hydroxy ethyl methacrylate (pHEMA) posterior chamber intraocular lens. Surgeries were performed by two senior surgeons with experience in both ECCE and phacoemulsification.
Preoperative, intraoperative, and postoperative data were collected using the WHO computerized surgical record (CSR) form and analyzed using the monitoring cataract surgical outcome (MCSO) software version 2.4 of the International Centre for Eye Health (ICEH) London, England.
Visual acuity was assessed on day 1 and then at 1 week, 4 weeks, and 12 weeks postoperatively. Visual outcomes were categorized based on the WHO standard of 6/6-6/18 being good outcome, <6/18-6/60 borderline outcome, and <6/60 poor outcome.
| Results|| |
A total of 360 eyes of 352 patients were studied. One hundred and eighty had conventional ECCE and 180 had phacoemulsification. There were 244 males (69%) and 108 females (31%), giving a male to female ratio of 2.3:1. The male to female ratio was 2.4:1 in the ECCE group and 2.1:1 in the phacoemulsification group. The age range of the patients was between 40 years and 90 years, with a mean age of 59.9 ± 9.85 years. The mean age was similar in both the groups, with 59.87 ± 10.3 years in the ECCE group and 59.41 ± 10.05 years in the phacoemulsification group. [Table 1] shows the age and sex distribution of the patients studied.
Three hundred and fifty six (99%) eyes, out of which 179 were in the ECCE group and 177 were in the phacoemulsification group were examined at the first follow-up visit at 1 week. Three hundred and fourteen eyes (87%), out of which 159 were in the ECCE group and 155 were in the phacoemulsification group were examined at the second visit at 4 weeks while 225 eyes (63%), out of which 108 were in the ECCE group and 117 were in the phacoemulsification group were examined at the third follow-up visit at 12 weeks. Similar numbers were lost to follow-up in the two groups, as shown in [Table 2].
The visual acuity in the eyes examined on postoperative day 1 had a good outcome (6/6-6/18) in 96 eyes (27%) in both the groups. Of these, 10 (6%) eyes were from the ECCE group and 86 (48%) eyes were from the phacoemulsification group. This difference was statistically significant (x2 = 82.045P< 0.0001). Visual acuity was borderline (<6/18-6/60) in 217 (60%) eyes, out of which 141 (78%) eyes were from the ECCE group and 76 (42%) eyes were from the phacoemulsification group. Poor visual acuity of <6/60 was recorded in 47 (13%) eyes, out of which 29 (16%) eyes were from the ECCE group and 18 (10%) eyes were from the phacoemulsification group. [Table 3] shows visual acuity on postoperative day 1.
|Table 3: Presenting visual acuity in operated eyes on first postoperative day|
Click here to view
Three hundred and fifty six eyes were examined at 1-week postoperative period; four (1%) were lost to follow-up, out of which one was from the ECCE group and three were from the phacoemulsification group.
Visual acuity was 6/18 or even better in 193 eyes, out of which 55 (31%) were from the ECCE group and 138 (78%) were from the phacoemulsification group; this difference was statistically significant (x2 = 80.11P < 0.0001). [Table 4] shows visual acuity at 1 week.
Three hundred and fourteen eyes were examined at 4 weeks, out of which 159 were from the ECCE group and 155 from the phacoemulsification group. At the 4 week-postoperative period, 200 eyes had visual acuity of 6/18 or better, out of which 73 (46%) eyes were from the ECCE group and 127 (82%) eyes were from the phacoemulsification group. This difference was statistically significant (x2 = 44.05P< 0.0001). Visual acuity at 4 weeks is shown in [Table 5].
Two hundred and twenty five eyes (63%) were examined at 12 weeks, out of which 108 were from the ECCE group and 117 were from the phacoemulsification group. The visual acuity was 6/18 or even better in 178 eyes, out of which 74 (68.5%) eyes were from the ECCE group and 104 (88.9%) eyes were from the phacoemulsification group. This observed difference was statistically significant (x2 = 14.02P< 0.002). Visual acuity at 12 weeks is shown in [Table 6].
| Discussion|| |
There are various parameters for measuring the visual outcome after cataract surgery and these include visual acuity, quality of life, and economic rehabilitation. Of these, visual acuity is probably the most suited for routine use by the ophthalmologist to measure performance and quality of service.
The mean age of the patients in this study (59.9 ± 9 years) was similar to that reported in a study in Kuwait, where the mean age was 64 ± 28.5 years. The male to female ratio (2.3:1) was higher than that reported in Kuwait that was 1:1; this could be attributed to sociocultural factors in Kuwait where males are more financially empowered and females require the consent and support of their spouses to seek medical services.
The follow-up rate at 4 weeks (87%) was similar to that reported in Kenya (88%) and Sierra Leone (87%) in patients who had cataract surgery. A study in Pakistan recorded a follow-up rate of 61.2% at 1 week, 42.8% at 4 weeks, and 10.2% at 12 weeks; these values are much lower than that in this study. Another study in the UK recorded follow-up rates of 95% and 93% at 3 weeks and 3 months, respectively. This higher follow-up rate in the UK could be due to patients being more enlightened and the presence of a well-organized medical care structure that makes it easier to recall patients. The number of patients lost to follow-up in this study was similar in both the ECCE and phacoemulsification groups; hence, this is unlikely to have caused a significant bias in the study.
The proportion of eyes with good outcome (6/6-6/18) on postoperative day 1 in the ECCE group (6%) was similar to that in Kaduna, Kaduna State, Nigeria (6%), but less than that in Orlu, Imo State, Nigeria (29.6%). In the phacoemulsification group, the proportion of good outcome (48%) on postoperative day 1 was much lower than that reported in Nepal (83.5%).
At 4 weeks postoperatively, both the groups showed an improvement in visual acuity, with good outcome in the phacoemulsification group (82%) that was almost double than that of the ECCE group (46%). A retrospective study in Kuwait recorded a best corrected visual acuity of 6/12 or even better at 4 weeks in 70.9% of the patients who had ECCE and 85.4% of those who had phacoemulsification; in the UK at 6 weeks, spectacle-corrected visual acuity of 6/18 or even better was recorded in 78% and 90% of the patients who had EECE and phacoemulsification, respectively.
The presenting visual acuity of 6/18 or even better at 12 weeks postoperatively in the ECCE group (68.5%) fell short of the 80% good outcome recommended by WHO; however, in the phacoemulsification group it was within this recommendation (89%). There was a statistically significant difference in good outcomes between the ECCE group and the phacoemulsification group at all postoperative visits in this study. In the UK, there was a statistically significant difference in visual outcome between ECCE and phacoemulsification at 3 weeks, 6 weeks, and 3 months postoperatively. At the 6-month and 1-year postoperative periods, there was a slight difference in the visual outcomes between the two groups though this difference was not statistically significant.
WHO recommends that borderline outcome (<6/18-6/60) should be less than 15% at 12 weeks; the ECCE group (39%) fell short while the phacoemulsification group (9%) was within this recommended limit. In a cataract surgical audit that consisted of patients who had both ECCE and phacoemulsification in Pakistan, only 1.3% of the patients had borderline outcome at 12 weeks postoperatively. The percentage of eyes with a poor visual outcome (<6/60) at 12 weeks were within <5%, as recommended by WHO, in both the ECCE (1%) and phacoemulsification (3%) groups. A study in Brazil showed that phacoemulsification was a more efficient procedure compared to ECCE as patients required less postoperative visits and hence, less overall expenditure of the health care system.
| Conclusion|| |
From the result of this study and previous studies,, phacoemulsification has been found to give better postoperative visual acuity in the early and intermediate postoperative periods compared to ECCE. Unfortunately, majority of the patients who require cataract surgery in the developing world have no access to phacoemulsification. There is, therefore, a need to make this procedure available and affordable, especially among resource-limited patients.
Financial support and sponsorship
Conflicts of interest
There are no conflicts of interest
| References|| |
Jennifer E, Darwin CM. Epidemiology of age-related cataract. J Comm Eye Health 2002;15:2-6.
Brian G, Taylor H. Cataract Blindness. Challenges for 21st
Century. WHO; 2001. p. 79, 249.
Abdull MM, Sivasubramaniam S, Murthy GV, Gilbert C, Abubakar T, Ezelum C,et al
.; Nigeria National Blindness and Visual Impairment Study Group. Causes of blindness and visual impairment in Nigeria: The Nigeria National Blindness and Visual Impairment Survey. Invest Ophthalmol Vis Sci 2009;50:4114-20.
Javitt JC, Wang F, West SK. Blindness due to cataract: Epidemiology and prevention. Annu Rev Public Health 1996;17:159-77.
Jamson JT, Morsley WH, Mearson AR, Babadilla JL. Disease Control in Developing Countries. Oxford: Oxford Medical Publications; 1993. p. 635-45.
Lundstrom M, Brege KG, Floren I. Impaired visual function following cataract surgery. An analysis of poor outcome as defined by catquest questionnaire. J Cataract Refract Surg 2000;83:101-8.
Abdulmoaty S, Behbehani AM, Aljazzaf A, Grigis N, Eslah E, Marouf T,et al
. The Kuwai cataract outcome study. A 12-month evaluation. Med Princ Pract 2006;15:180-4.
Yorton D, Forster A. Audit of extracapsular cataract extraction and posterior chamber lens Implantation as a routine treatment for age-related cataract in east Africa. Br J Ophthalmol 1999;83:897-901.
Cook NJ. Evaluation of high volume extracapsular cataract extraction and posterior chamber lens implantation in Sierra Leone, west Africa. Br J Ophthalmol 1996;80:698-701.
Paracha Q. Cataract surgery at Marie Adelaide Leprosy Centre Karachi: An audit. J Pak Med Assoc 2011;61:688-90.
Minnasian DC, Rosen P, Dart JK, Reidy A, Desal P, Sidhu M,et al
. Extracapsular cataract extraction compared with small incision surgery by phacoemulsification: A randomised trial. Br J Ophthalmol 2001;85:822-9.
Eruchalu UV, Pam VA. A preliminary review of extracapsular cataract extraction with posterior chamber intraocular lens implantation in Kaduna, Nigeria. Niger J Ophthalmol 2004;13:26-31.
Obiodu HC, Obi BI, Anyalebechi OC. Monitoring cataract surgical outcome in a public hospital in Orlu, south east Nigeria. Niger Med J 2009;50:77-9.
Henning A, Singh S, Winter I, Yorston D. Can phaco be a cost-effective solution to cataract blindness? Costs and outcomes in Nepal. Eye (Lond) 2010;24:1104.
Mendonça PT, Mendonça LT, Rosa AA, Silveira LC. Life quality assessment of patients after phacoemulsification or extracapsular cataract extraction. Arq Bras Oftalmol 2014;77:12-6.
[Table 1], [Table 2], [Table 3], [Table 4], [Table 5], [Table 6]