HIGH-VOLUME INTRAOCULAR-LENS SURGERY IN A RURAL EYE CAMP IN INDIA

BACKGROUND AND OBJECTIVE: The appropriate surgical treatment for the e normous number of patients in developing nations who are blind due to cataract is a hotly debated issue. The authors' objective is to demons trate that modern surgical techniques (extracapsular cataract extracti on and intraocular lens implantation, phacoemulsification and intraocu lar lens implantation) can be performed in a high-volume, cost-effecti ve manner, even in temporary settings. The authors believe that re app roach to cataract blindness is not simple intracapsular cataract extra ction, but rather the challenge of(1) training all ophthalmic personne l in modern techniques (microsurgery, biometry), (2) training managers in higher levels of organizational skill, and (3) doing these things in the face of limited resources. PATIENTS AND METHODS: A total of 129 8 surgeries were performed in a public eye camp in Ganeshpuri, India ( 50 miles north of Bombay). Of these, 1214 (93.5%) of the patients rece ived intraocular lens (IOL) implants. Ninety-three percent (1032/1108) of the patients who underwent extracapsular cataract extraction (ECCE ) and IOL implantation and 89% (83/93) of the patients who underwent p hacoemulsification and IOL implantation returned for follow-up. RESULT S: Postoperatively, 48% (498/1032) of the patients who underwent ECCE and IOL implantation achieved corrected vision of 6/12 or better and 6 5% (671/1032) attained corrected vision of 6/18 or better. Of the pati ents who underwent phacoemulsification and IOL implantation, 59 of 83 (71%) attained vision of 6/12 or better with correction and 68 of 83 ( 79%) achieved vision of 6/18 or better with correction. These results are almost identical to those obtained by the authors in their Ganeshp uri 1991 camp. Surgical complication rates were comparable to those re ported in hospital-based studies. CONCLUSION: For this type of camp to operate efficiently, there must be standardization of skills among op hthalmic personnel, costs must be contained, and the organizational sk ills necessary to ensure smooth functioning of the camp must exist. Ho wever, on the basis of their data, these authors believe that with sui table organizational and surgical facilities, IOL implantation can be successfully performed in high-volume surgical eye camps.