Randomized controlled trial of anterior-chamber intraocular lenses in Nepal: long-term follow-up

Most of the estimated 20 million people who are blind with cataracts live i n rural areas of developing countries, where expert surgical resources are scarce. We have studied the use of multiflex open-loop anterior-chamber int raocular lenses (ACIOL) in high-volume few-cost surgery. Between 1992 and 1 995, a total of 2000 people attending Lahan Eye Hospital, Nepal, with bilat eral cataracts reducing vision to less than or equal to 6/36 were randomly allocated to receive intracapsular extraction (ICCE) with aphakic spectacle s, or ICCE with an ACIOL. We re-examined the cohort (1305/2000, 65%) betwee n November 1996 and April 1997 and report the findings in this article. The re were 13 new cases of poor visual outcome (best corrected vision <6/60) a rising after one year: 9 in the ACIOL group and 4 in the control group; odd s ratio 2.1 (95% confidence interval, 0.59-9.55). The causes of poor outcom e were as follows: ACIOL group - retinal detachment (4 cases), cystoid macu lar oedema (2), epiretinal membrane (1), age-related macular degeneration ( 1), and late endophthalmitis (1); control group - retinal detachment (2 cas es), late endophthalmitis (1), and primary open-angle glaucoma with age-rel ated macular degeneration (1). In rural areas of developing countries, well -manufactured multiflex open-loop ACIOLs can be implanted safely by experie nced ophthalmologists after routine ICCE, avoiding the disadvantages of aph akic spectacle correction.