|Year : 1983 | Volume
| Issue : 7 | Page : 924-927
Surgical results: Comparison of patients operated in "eye camp" with patients operated in the hospital
Taraprasad Das, G Venkataswamy
Aravind Eye Hospital Madurai, India
Aravind Eye Hospital Madurai
Source of Support: None, Conflict of Interest: None
|How to cite this article:|
Das T, Venkataswamy G. Surgical results: Comparison of patients operated in "eye camp" with patients operated in the hospital. Indian J Ophthalmol 1983;31, Suppl S1:924-7
|How to cite this URL:|
Das T, Venkataswamy G. Surgical results: Comparison of patients operated in "eye camp" with patients operated in the hospital. Indian J Ophthalmol [serial online] 1983 [cited 2020 May 26];31, Suppl S1:924-7. Available from: http://www.ijo.in/text.asp?1983/31/7/924/29707
The concept of delivery of eye care in rural areas through `eye camps' or `mobile eye hospitals' has been well recognised by the national and international agencies. Particularly in a developing country like ours where permanent health delivery infrastructures in rural areas are not yet well established and where social, economical and educational factors play a major role, delivery of comprehensive eye care through `rural eye camps' is a significant step forward in eradicating curable blindness caused by cataract Apart from precise planning for successful `rural eye camps', consistently good surgical quality and results-approximating the results obtained in any well equipped hospital-are essential. Otherwise not only is the primary aim of curing blindness caused by cataract defeated, but also the age old fear of surgery in rural population precipitated.
Good surgical quality is achieved with skilled and experienced surgeons, but followup of the patients operated in `camps' is not always feasible in a country like ours. Keeping these factors in mind, a follow-up study of patients operated in one of our `camps' was carried out and matched with a random sample of patients operated in our hospital to find out the differences in surgical quality and results, if any, between the two groups operated in different set-ups.
| Materials and methods|| |
The `camp' selected for this study was held 300 kms. west of Madurai in the last week of February 1982. There was no particular reason why this `tamp' was selected for the study except that it was possible to contact the patients through the local organisers and the fact that only one hundred patients were operated, made the task a little easier. The patients operated in the `camp' were visited twice after discharge from the camp. First, at the end of the first month and then again after an interval of three months. On the first review their vision was recorded with +100 Sph. spectacle provided to them at the time of discharge. Then the operated eye was examined to assess the surgical quality and the fundus was examined by direct ophthalmoscope. All findings were recorded. On the second review, apart from examining the eye externally and examining the fundus, the patients were refracted to find out the best visual acuity with aphakic correction.
Like any other `camp' conducted by our hospital, this camp was also organised on the method devised by one of us (Venkata swamy), where the patients after registration go through preliminary testing of vision with Snellen's chart, pareliminary examination by doctors, recording of intra ocular pressure by Schiotz tonometer, testing the patency of naso-lacrimal duct by syringing the lacrimal passage, refraction when necessary and final examination by doctors for selection of patients for cataract operation. Blood pressure and qualitative urine sugar estimation by Benedict's method were made in all the cases thus selected. All hypertensive and diabetic patients were not operated in the camp' but referred to our hospital. Trial bandage was applied for the patients finally selected and they were operated the morning following admission, by a team of six doctors. Operating room preparation consisted of white washing the walls a week before the date of operation, washing the floor thoroughly a day prior to surgery and sterilizing the room with formalin for twenty four hours.
All the operations were performed using the technique of limb al based flap, ab-externo limbal incision, peripheral iridectomy and cryo extraction of lens. The wound was closed with 5 interrupted corneoscleral sutures of 8-0 silk. At the end of surgery a few drops of gentamycin were instilled into the conjunctival sac and the patients were usually made to walk to their beds. Patients were made ambulatory after twelve hours. Post-operative care was taken by a team of two doctors and two nurses and constituted of daily dressing with antibiotics locally. Local steroids were used from the third post-operative day. The postoperative findings and daily progress were recorded in the case sheets as is the practice in all our camps.
All the cataracts operated in the hospital have been performed under the microscope. The wound is closed with 7 or 9 interrupted sutures of 9-0 Ethilon material. For this comparative study, enough care was taken to get the sample from the hospital. The patients were selected at random from the number of patients operated in the same month, i.e. February 1982. All diabetics, hypertensives, patients below 40 years of age were excluded and cases not reviewed for at least three months were not accepted for the present study.
| Observations|| |
Out of one hundred cases operated in the camp, six eyes were lost to followup. The best visual acuity with aphakic correction three months following cataract operation in the two groups of patients, is shown in [Table - 1].
Approximately 46% of patients operated in the hospital had full visual recovery whereas 19% of the patients operated in the camp could recover the V/A of 6/6. About one fourth of the patients operated in the camp had 6/18 vision and in 16% of them V/Awas below 6/60 Visual acuity between 6/6 to 6/12 was achieved in 50% of camp patients and 85% of the hospital group of patients.
The causes of poor vision in both the groups of patients are summarised in [Table - 2].
In the hospital group, myopic degeneration in six eyes, macular degeneration in two eyes and primary optic atrophy in one eye accounted for low vision. In patients operated in the camp the causes of low vision were macular degeneration, central chorioretinitis, central retinal vein occulusion, fibrinous membrane in the pupillary area, non-absorbing hyphaema post-operative iris prolapse and retinal detachment. The retinal detachment seen in two patients operated in the camp were detected in the second review, three months following cataract extraction. Both these patients had 6/60 vision in the first review. In one case it was an accidental extracapsular cataract extraction and the other was intra-capsular cataract surgery. The fibrinous membrane in the pupillary area in one case was following partially absorbed hyphaema,
The amount and the nature of asigmatism observed in the two groups of patients arc shown in [Table - 3]. In over one-fourth of the patients in either group there was no asigmatism. But asigmatism in oblique axis and asigmatism with the rule were seen more in the patients operated in the camp than the hospital. The average cylindrical correction in the patients operated in the camp was 1.37D and in the hospital patients it was 1.14D.
The operative and post-operative complications in both the groups of patients are recorded in [Table - 4]. Though accidental extra capsular cataract operations were more in the random sample of the hospital patients, overall operative and post-operative complications occured more in the patients operated in the `camp'. Post-operative hyphaema was seen in five patients and iris prolapse was seen in one patient operated in the `camp', whereas in the patients operated in the hospital there was no incidence of iris prolapse and only one patient had post-operative hyphaema.
| Discussion|| |
Analysis of the patients operated in the camp shows that through full visual recovery (V/A of 6/6) was much less compared to the random sample of patients operated in the hospital, half of these had corrected vision between 6/12 and 6/6. Approximately one fourth of the camp patients could regain 6/18 vision though externally eye was clear and fundus as visualised under direct ophthalmoscope did not reveal any gross pathology accountable for the low visual acuity. Since many of the patients operated in the mobile eye camps are usually illiterate in whom subjective recording of vision is done with the help of `E' Chart, it is not always possible to record visual acuity accurately. However, in 16% of the patients low vision was due to inherent fundus pathology.
Out of five eyes operated in the camp who had post-operative hyphaema, anterior chamber was clear of blood in three eyes before discharge. In one eye it was only partially absorbed leaving behind a fibrinous membrane in the pupillary area, ,sub and in one case hyphaema did not clear at all. This last mentioned patient had bilateral chronic uveitis with complicated cataract and low intra ocular tension, and since he was unwilling to come to our hospital for proper evaluation before surgery, he was operated in the camp with a very guarded prognosis. His eye started bleeding on the table as soon as iridectomy was made and we strongly suspect that he had rubeosis iridis.
Though full visual recovery in the patients operated in the camp is less compared to that of the patients operated in the hospital, almost near total vision (6/12 and above) was restored in 50% of patients and 80% of the patients had useful good vision (6/24 and above). In an evaluation of eye camps in one district of Madhya Pradesh (India), it is being reported that as high as 90% of the patients blind due to cataract would not have got their eyes operated had there not been a camp and that is almost true to other parts of India too due to the complex psycho-socio-economical factors. In such a situation the surgical results obtained by us in cataract operation camps are positively encouraging though there are no reasons for complacency.
| Summary|| |
Cases operated in one of the camps by us being analysed and the surgical results are compared with a random sample of patients operated in the hospital. Half of the patients operated in the camp visual recovery was from 6/12 to 6/6. One fourth of patients could regain only 6/18 vision and in 16% low vision was due to inherent fundus pathology. Considering the fact that many of the patients suffering from blindness due to cataract would not have got operated at all, our results are not discouraging. However, there is still scope for improvement.
| References|| |
Venkataswamy, G. 1981, Organisation of Rural Mass Eye Camps-(Eye Health in South-East Asia) SEA/Ophthal/WHO/36 pp 47-77.
Mahashabde, J.S. 1982, "Nayan Jyoti"-Survey and Evaluation of Eye Camps (Dhar District, Madhya Pradesh, India), Personal communication.
[Table - 1], [Table - 2], [Table - 3], [Table - 4]