|Year : 1984 | Volume
| Issue : 3 | Page : 165-168
Cataract surgery as an outdoor procedure in rural areas through mobile van
Arun Mathur, Pramod Sehgal, Sunil Kumar Narang
Department of Ophthalmology, LLRM Medical College Meerut, India
Department of Ophthalmology, LLRM Medical College. Meerut 250 102
Source of Support: None, Conflict of Interest: None
|How to cite this article:|
Mathur A, Sehgal P, Narang SK. Cataract surgery as an outdoor procedure in rural areas through mobile van. Indian J Ophthalmol 1984;32:165-8
The problem of back log of cataract in India is enormous. Due to various reasons, the rural population do not submit themselves for cataract operation. The camp approach is well established as a temporary measure. We endeaveoured to do surgery at the door-step of the patient in a rural mobile van. That is to get operated free at his door-step. This service could be readily acceptable during any time of the year.
| Material and method|| |
This project was carried out through Rural Mobile Health van which has an operation theatre with operation table, sterilizers. good operation light. generator, emergency medicines, oxygen cylinders and furniture to run-out-patient clinic.
Publicity of eye relief work was carried out through local medical practitioners, social workers attached to the Primary Health Centre. Once this extra large size van visits a village and its generator in run, itself attracts crowd in villages.
Cataract surgery was performed in Rohta, Kalina, Babugarh, Shahjahanpur and Macchra villages 20-25 K.M. around Meerut.
A total population of 50.000 was covered and 448 cases were operated for cataract.
Visits to the villages was three alternate days in a week and was carried out all around the year. patients fit for surgery were given streptopenicillin drops and two tablets of Diamox to he taken before surgery and were told to come after a bath and clean clothes on the day of surgery.
The premedication Tab. Triflupromazine (Sequil) 10 mg was given as a routine. It was supplemented with Inj. pethedine 100 mg or Inj. Calmpose 10 mg whenever necessary. Cataract extraction was done with cryounit after making knife incision and fornix based conjunctival flap. Corneoscleral sutures of 8(' virgin silk was given 7 to 8 in number and conjunctival flap was stitched over the wound. Subconjunctival injection of Gentamicin was given [Figure - 1][Figure - 2][Figure - 3][Figure - 4].
Postoperatively one eye was bandaged and patient was allowed to walk back to his home. He was given Tab. Aspirin for pain if any, and was called for dressing on third day to the mobile van. Patient was instructed to take rest at home and to have light food for two days in postoperative period.
The dressings were done on alternate days and green shades was given on 6th postoperative day. Patients were called for follow up every week for 5 weeks and then glasses were prescribed after refraction.
| Observations|| |
A total of 448 patients were operated out of which 264 were females and 184 males. Patients in all the age groups were operated and age group of 50-60 years formed the largest category accounting almost to 50% of the patients.
Two hundred and thirty two eyes with mature cataract were operated and 32 eyes with immature cataract were operated who did not have any improvement with glasses and the vision was not sufficient to carry out the routine work of patient.
Out of 448 cases 24 had cataract only in one eye but the maturity of cataract warranted the lens extraction to prevent the complication.
All the lens extraction were done with cryoprobe except 12 cases where extracapsular extraction was planned according to preoperative and operative circumstances.
Operative and postoperative complications were not in excess of those found in hospital conditions.
All the complications were managed successfully except one case who developed endophthalmitis and could not gain any useful vision in spite of all measures. This case was one of the cases in whom extracapsular extraction was done.
The results of visual improvement were quite encouraging and about 90% cases gained vision upto 6/18 or better and the patients who had less vision had corneal opacities (retinal or macular pathology).
| Discussion|| |
This new method of Eye Relief Service was found to be practical where operations were done at the door-step of the patient with postoperative stay at his own house without the need of an attendant, no restriction on his movements and food in the postoperative period. This method was found to be most acceptable to the elderly, poor, visually handicapped cataract patients found lying untreated and neglected in their homes. Nobody in the family has either time or money to take their elders to a town hospital for surgery. Surgery could be done in all months of the year including rainy and hot months of the summer thus breaking up the belief that surgery should be done only in winter months and only when cataract is mature.
Utilizing methods for complete asepsis in the operation theatre of mobile van and operating cataract with modern techniques of cryosurgery and multiple corneoscleral sutures, it was possible to do it as an outdoor procedure without any postoperative complications due to immediate mobility allowed to the patient.
The incidence of postoperative complications was less as compared to those seen in hospitals in equal number of cases operated. It was probably due to the senior surgeon doing all the cases in this project and the whole team being well trained to do this field surgery.
The postoperative follow up which is too short and casual in camp surgery was complete and carried out for 6 weeks after operation in this study. Patients turned up regularly for follow up which sometimes become difficult for a patient getting operated in a hospital because of distance and expenditure involved.
Similar work carried out-by a team of senior and junior surgeons with two theatre assistants in a mobile van can do about 60 cataract operation per week, thus a target of about 2500 cases can he achieved in rural areas per mobile van every year.
This will go a long way to increase our target of dealing with cataract blindness in addition to surgery done through eye camps and in hospitals.
| Summary|| |
A new strategy for prevention of cataract blindness in rural areas has been successfully carried out in villages.
Four hundred and forty-eight cases of cataract were operated as outpatient in the operation theatre of mobile van using cryoextraction and multiple corneoscleral sutures. Patients accepted this method as it was convenient, carried out at their doorstep free of cost and without any disturbance to their daily routine. Surgical results were similar or even better than the hospital surgery. Follow up was carried out for 6 weeks and glasses were prescribed after refraction.
[Figure - 1], [Figure - 2], [Figure - 3], [Figure - 4]
[Table - 1], [Table - 2], [Table - 3], [Table - 4]