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Quality cataract surgery in Asia in the year 2000
ABSTRACTS EDITED BY GEORGE B. BARTLEY, M.D. mKmammMÈÊmmmmMHÊmÊKimMmmmMœmmm
• Quality cataract surgery in Asia in the year 2000. Lim ASM*. Asia-Pacific J Ophthalmol 1996;8:7-9.
G
* Simultaneous bilateral cataract extraction in the UK. Beatty S*, Aggarwal RK, David DB, Guarro M, Jones H, Pearce JL. Br J Ophthalmol 1995;79: 1111-4.
REAT MEDICAL ADVANCES OF THE 19TH CENTURY
occurred in Europe and major eye institutes were founded during the 20th century in North America. In this essay, which was excerpted from a lecture presented at the Second International Ophthalmologic Conference in Beijing in July 1995, the author predicts that Asia is poised for "spectacular" develop ments in ophthalmology in the next century because of the region's vast potential for economic growth. "Ophthalmology will emerge as the most important surgical discipline because quality cataract surgery can prevent human misery and social economic agony to millions. . . ." Currently, approximately two thirds of cataract extractions in Asia are performed using the intracapsular technique. The author re viewed the pros and cons of phacoemulsification and concluded that by the year 2000 less than 10% of cataract extractions in Asia will be performed by that technique. In most parts of the continent phacoemul sification would be "inappropriate" because of its increased cost compared with extracapsular cataract extraction, the need for greater technical support, and the reluctance of Asians to accept a new technique as superior unless visual outcome can be proven to be superior. Rather, the author believes that extracapsu lar cataract extraction will yield results of 20/40 or better in 98% of patients, "giving great visual satisfac tion."—George B. Bartley *Depanment of Ophthalmology, National University of Singapore, Singapore.
VOL.121, N o . 4
T
HE AUTHORS REVIEWED THE OUTCOMES OF 319 PA-
tients who underwent simultaneous bilateral ex tracapsular cataract extraction with posterior cham ber intraocular lens implantations at one institution between 1985 and 1991. Exclusion criteria included pseudoexfoliation of the lens capsule, posterior synechiae, and any predisposing condition for ocular infection. Infection prophylaxis included conjunctival cleansing with 5% aqueous povidine-iodine and a subconjunctival injection of cefuroxime at the time of induction of general anesthesia, a separate irrigation system and surgical instruments for each eye, and the administration of corticosteroid-antibiotic eyedrops postoperatively. The second eye of each pair under went operation only if the cataract extraction in the first eye was performed without serious complication. Intraoperative complications occurred in 7.7% of the 638 eyes and included posterior capsule rupture (five eyes; 0.8%) and vitreous loss (two eyes; 0.3%). Postoperative complications included an increase of intraocular pressure greater than 22 mm Hg (19 eyes; 3.0%), clinically apparent cystoid macular edema (12 eyes; 1.9%), uveitis (nine eyes; 1.4%), and endophthalmitis (one eye; 0.15%). The final best-corrected visual acuity was 20/40 or better in 514 eyes (82%); 41% of eyes achieved 20/20 vision. Although the authors do not advocate routine simultaneous bilater al extracapsular cataract extraction, they concluded that the procedure is safe and not associated with an
ABSTRACTS
463
• Quality cataract surgery in Asia in the year 2000. Lim ASM*. Asia-Pacific J Ophthalmol 1996;8:7-9.
G
* Simultaneous bilateral cataract extraction in the UK. Beatty S*, Aggarwal RK, David DB, Guarro M, Jones H, Pearce JL. Br J Ophthalmol 1995;79: 1111-4.
REAT MEDICAL ADVANCES OF THE 19TH CENTURY
occurred in Europe and major eye institutes were founded during the 20th century in North America. In this essay, which was excerpted from a lecture presented at the Second International Ophthalmologic Conference in Beijing in July 1995, the author predicts that Asia is poised for "spectacular" develop ments in ophthalmology in the next century because of the region's vast potential for economic growth. "Ophthalmology will emerge as the most important surgical discipline because quality cataract surgery can prevent human misery and social economic agony to millions. . . ." Currently, approximately two thirds of cataract extractions in Asia are performed using the intracapsular technique. The author re viewed the pros and cons of phacoemulsification and concluded that by the year 2000 less than 10% of cataract extractions in Asia will be performed by that technique. In most parts of the continent phacoemul sification would be "inappropriate" because of its increased cost compared with extracapsular cataract extraction, the need for greater technical support, and the reluctance of Asians to accept a new technique as superior unless visual outcome can be proven to be superior. Rather, the author believes that extracapsu lar cataract extraction will yield results of 20/40 or better in 98% of patients, "giving great visual satisfac tion."—George B. Bartley *Depanment of Ophthalmology, National University of Singapore, Singapore.
VOL.121, N o . 4
T
HE AUTHORS REVIEWED THE OUTCOMES OF 319 PA-
tients who underwent simultaneous bilateral ex tracapsular cataract extraction with posterior cham ber intraocular lens implantations at one institution between 1985 and 1991. Exclusion criteria included pseudoexfoliation of the lens capsule, posterior synechiae, and any predisposing condition for ocular infection. Infection prophylaxis included conjunctival cleansing with 5% aqueous povidine-iodine and a subconjunctival injection of cefuroxime at the time of induction of general anesthesia, a separate irrigation system and surgical instruments for each eye, and the administration of corticosteroid-antibiotic eyedrops postoperatively. The second eye of each pair under went operation only if the cataract extraction in the first eye was performed without serious complication. Intraoperative complications occurred in 7.7% of the 638 eyes and included posterior capsule rupture (five eyes; 0.8%) and vitreous loss (two eyes; 0.3%). Postoperative complications included an increase of intraocular pressure greater than 22 mm Hg (19 eyes; 3.0%), clinically apparent cystoid macular edema (12 eyes; 1.9%), uveitis (nine eyes; 1.4%), and endophthalmitis (one eye; 0.15%). The final best-corrected visual acuity was 20/40 or better in 514 eyes (82%); 41% of eyes achieved 20/20 vision. Although the authors do not advocate routine simultaneous bilater al extracapsular cataract extraction, they concluded that the procedure is safe and not associated with an
ABSTRACTS
463