Dataset Information

Seven-year trends in cataract surgery indications and quality of outcomes at Aravind Eye Hospitals, India.

ABSTRACT:

Purpose

To report trends in cataract surgery indications, visual acuity outcomes, complication rates and reoperation rates at ten Aravind Eye Hospitals in Tamil Nadu, India.

Methods

In this retrospective database study we analyzed seven years of data of cataract surgeries at Aravind during January 1, 2012 to December 31, 2018. Our main outcome measures were preoperative and 1-month postoperative uncorrected visual acuity (UCVA) and best-corrected visual acuity (BCVA); and rates of intraoperative complications and reoperations. We performed Cochran-Armitage trend tests.

Results

In 1.86 million eyes that underwent cataract surgery, the percentage of eyes undergoing phacoemulsification (PE) showed an increasing trend (p < 0.0001), from 26.8% in 2012 to 33.5% in 2018. The percentage of eyes undergoing manual small incision cataract surgery (SICS) showed a decreasing trend (p < 0.0001), from 70.0% in 2012 to 65.1% in 2018. For SICS, the percentages of eyes with good postoperative UCVA and BCVA showed increasing trends (p < 0.0001 for each), and the percentages of eyes with poor postoperative UCVA and BCVA showed decreasing trends (p < 0.0001 for each). Results for PE surgeries were mixed. For both PE and SICS rates of intraoperative complications showed a declining trend (p < 0.0001 for each) and a slight increasing trend for reoperations (PE p < 0.02; SICS p < 0.0001).

Conclusions

During this seven-year period there were noticeable trends in cataract surgeries performed at Aravind in terms of the mix of surgical procedures, preoperative vision, and cataract surgical outcomes.

SUBMITTER: Ravindran RD

PROVIDER: S-EPMC8225659 | biostudies-literature |

REPOSITORIES: biostudies-literature

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Project description:To evaluate cataract surgery visual outcomes and associated risk factors in rural secondary level eye care centers of L V Prasad Eye Institute (LVPEI), India.The Eye Health pyramid of LVPEI has a network of rural secondary care centres (SCs) and attached vision centres (VCs) that provide high quality comprehensive eye care with permanent infrastructure to the most disadvantaged sections of society. The most common procedure performed at SCs is cataract surgery. We audited the outcome of a random sample of 2,049 cataract surgeries done from October 2009-March 2010 at eight rural SCs. All patients received a comprehensive ophthalmic examination, both before and after surgery. The World Health Organization recommended cataract surgical record was used for data entry. Visual outcomes were measured at discharge, 1-3 weeks and 4-11 weeks follow up visits. Poor outcome was defined as best corrected visual acuity <6/18.Mean age was 61.8 years (SD: 8.9 years) and 1,133 (55.3%) surgeries were performed on female patients. Pre-existing ocular co-morbidity was present in 165 patients (8.1%). The most common procedure was small incision cataract surgery (SICS) with intraocular lens (IOL) implantation (91.8%). Intraoperative complications were seen in 29 eyes (1.4%). At the 4-11 weeks follow-up visit, based on presenting visual acuity (PVA), 61.8% had a good outcome and based on best-corrected visual acuity (BCVA), 91.7% had a good outcome. Based on PVA and BCVA, those with less than 6/60 were only 2.9% and 1.6% respectively. Using multivariable analysis, poor visual outcomes were significantly higher in patients aged ≥70 (OR 4.63; 95% CI 1.61, 13.30), in females (OR 1.58; 95% CI 1.04, 2.41), those with preoperative comorbidities (odds ratio 4.68; 95% CI 2.90, 7.57), with intraoperative complications (OR 8.01; 95% CI 2.91, 22.04), eyes that underwent no IOL or anterior chamber-IOL (OR 12.63; 95% CI 2.65, 60.25) and those undergoing extracapsular cataract extraction (OR 9.39; 95% CI 1.18, 74.78).This study demonstrates that quality cataract surgeries can be achieved at rural SCs. The concept of the LVPEI SCs can be applied to other developing countries, allowing rural patients to attain better vision through cataract surgery. Despite improvements in quality of cataract surgery, gender discrimination in terms of outcome continues to be an issue and needs further investigation.