Outcomes of extracapsular surgery in eye camps of eastern Nepal

Extracapsular cataract (ECCE) surgery is becoming increasingly popular in surgical eye camps of developing countries. This study assesses the outcome of 166 eyes at 6 weeks and 14 and 32 months after ECCE with and without implantation of intraocular lens in refugee camps of eastern Nepal.

All patients operated on in seven refugee camps during the 3 years before the assessment were included in the study population. Visual acuity, examination of anterior segment and posterior segments, and grading of capsular opacification using a standardised grading system were performed.

Of 166 eyes examined, of which 49.4% were aphakic, 58% of eyes had very poor functional vision (WHO severe visual impairment-VA <6/60). After refraction and best correction 19% still had very poor vision. The aphakic eyes had both significantly poorer functional and best corrected vision than the pseudophakic eyes. In patients with intact posterior capsule clinically significant posterior capsular opacification was observed in over 10% of eyes at 14 months and 30% at 32 months.

It was found that ECCE surgery in eye camps in this setting gave unacceptable outcomes because of a high rate of capsular rupture and posterior capsular opacification. Careful consideration should be given to the quality of the surgical set up and available resources and possibilities of postoperative follow up when ECCE is introduced in eye camps.