[Teaching phacosection in a tropical setting]
Purpose:
The aim of this study was to prospectively evaluate the training of a Malagasy ophthalmologist, already proficient in classic manual extracapsular cataract extraction (ECCE), in a small incision manual technique (phacosection).
Materials And Methods:
Within the activity of the Sight First program to fight blindness in Madagascar, the ophthalmologist of Majunga recruited patients presenting total white cataracts. These patients were operated by phacosection using the local hospital's usual instrumentation along with two specific phacosection instruments and extra single-use material (a precalibrated 3.2 mm knife and viscoelastic products). Peribulbar anesthesia with eye pressure was provided. Postoperative follow-up (visual acuity and corneal status) was conducted on days 1, 7 and 30.
Results:
Forty-four eyes were operated, the first seven by the instructor assisted by the local ophthalmologist, the next 36 by the local ophthalmologist assisted by the instructor. Five postoperative complications were noted: two cases of posterior capsular rupture (one during implantation) and three cases needing reoperation with aspiration of residual cortical masses. Induced astigmatism was low and visual rehabilitation was good, with all corneas clear at day 30.
Discussion:
The results are quite acceptable given the training period, with only two marked complications (one not related to the operative technique) and good visual rehabilitation in less than 2 weeks. This small incision technique allowed reduction of induced astigmatism and risk-free management of total white cataracts (independent of operator).
Conclusion:
Small incision manual ECCE by phacosection is a safe, possible management option for difficult cataracts in a tropical setting with only a small increase in cost. Moreover, the training of an ophthalmologist mastering classic manual ECCE appears rapid and risk-free for patients.