Low-cost high volume extracapsular cataract extraction with posterior chamber intraocular lens implantation in nepal

Objective: To improve current clinical practices and ways of thinking about the problem of curable Third-World blindness resulting from cataract. Design: A two-site prospective, nonrandomized, comparative clinical trial. Participants: Patients from 2 distinct surgical venues underwent cataract s urgery following the same carefully outlined protocol: 62 consecutive cases from the Tilganga Eye Centre in Katmandu, Nepal, and 207 cases from a remo te eye camp in rural Chaughada, Nepal. Intervention: Extracapsular cataract extraction with posterior chamber intr aocular lens (IOL) implantation surgery using a technique developed by Dr. Sanduk Ruit of the Tilganga Eye Centre in conjunction with the Medical Dire ctorate of the Fred Hollows Foundation of Australia. Also presented is the teaching method used to help make local doctors proficient in this techniqu e. Main Outcome Measures: Visual acuity recorded at 2 months after surgery as well as surgical complications. Results: Preoperative visual acuities for the 62 patients from the Tilganga Eye Centre ranged from 20/60 to light perception only (4 patients were unt ested), At 2 months after surgery, 87.1% had a best-corrected visual acuity of 20/60 or better. There were zero major surgical complications reported from the Tilganga group. Of the 207 patients at the Chaughada eye camp, pre operative visual acuities (recorded for 177 [85.5%]) ranged from 20/200 or greater to light perception only. One hundred eighty-nine (91.3%) of the pa tients returned for an examination at 2 months after surgery, at which time 54.5% had an uncorrected visual acuity of 20/60 or greater, improving to 7 4.1% with correction. There were six (2.9%) surgical complications document ed at Chaughada. Conclusions: Because the average operative time using the technique present ed here is less than 10 minutes per case and the cost per surgery is less t han $20, the surgical results are significant in addressing the massive pro blem of cataract blindness in the Third World. With some changes in preoper ative care, a simplified surgical technique, the development of local lens factories, and the implementation of teaching programs, effective lens impl antation cataract surgery can be done in high volume at affordable costs in remote areas of underserved nations.