UNILATERAL VERSUS SIMULTANEOUS BILATERAL CATARACT SURGERY IN A NIGERIAN EYE HOSPITAL
Nwosu
SNN
(MD, FMCOph, FWACS, FACS)1,
Ndulue
OI
(MBBS)2, Uba-Obiano CU (MBBS,
FMCOph)1
1Guinness Eye Centre Onitsha,
PMB
1534 Onitsha, Anambra State, Nigeria.
2Ebony Eye Specialist Clinic Onitsha.
Author for Correspondence: sabenwosu@gmail.com
Citation:
Nwosu SNN, Ndulue OI, Uba-Obiano CU.
Unilateral Versus Simultaneous Bilateral
Cataract Surgery
In A Nigerian
Eye
Hospital. Orient
Journal of Surgical
Sciences. Vol. 2.
January - December 2021: Page 14 - 19
ABSTRACT
Objective: To compare the
outcome of unilateral versus bilateral simultaneous cataract surgery at the
Guinness Eye Center Onitsha, Nigeria.
Materials and Methods: The visual
outcome and complications rates in patients who had bilateral simultaneous
cataract surgery (BSCS) intraocular lens implant between 01 January, 2014
and 31 December, 2016 and had been followed up for 6 months were compared with
those who had unilateral cataract surgery (UCS) within the same period.
Information on socio-demographic characteristics, domicile, pre-operative
visual acuity, visual acuity on last follow up, intra-operative complications, post-operative
complications and causes of poor vision were analyzed.
Results: Thirty nine patients with
bilateral simultaneous surgery and 142 with uniocular surgery were studied. The
age range was 6 – 93 years, median – 66years. There were 104 males (57.5%).
Pre-operatively 62 (79.5%) and 134 (94.4%) eyes had visual acuity <3/60 in
bilateral and uniocular surgery patients respectively. Post-operatively, 36
(46.1%) and 60 (42.3%) eyes of bilateral and uniocular surgery patients
respectively had unaided acuity ≥6/18. Post-operative acuity significantly
improved in both unilateral (X2 = 9.626; p<0.05) and bilateral (X2
= 9.556; p<0.05) surgeries. However, there was no statistically significant
difference in the improvement in visual acuity between unilateral and bilateral
surgeries (X2 = 0.562; p>0.05)
Intra-operatively, vitreous loss occurred in one (1.3%) BSCS
and 2 (1.4%) UCS patients. Post-operatively posterior capsule opacification
occurred in 10(12.8%) and 22 (15.5%) eyes of bilateral and uniocular surgery
patients respectively. Recurrent uveitis occurred in 8 (10.3%) and 13
(9.2%)eyes of bilateral and uniocular surgery patients respectively.
Post-operative endophthalmitis occurred in one (0.7%) eye of a uniocular
surgery patient.
Conclusion:
Simultaneous bilateral cataract extraction with intraocular lens implant has
visual outcome and complication rate similar to those of uniocular surgery. It
should be recommended for patients who do not want staged surgery and those who
cannot afford long hospital admission.
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INTRODUCTION
Cataract
is the commonest cause of blindness in Nigeria.1 Cataract accounts
for 50% of blindness in Nigeria - about 500,000 persons in immediate sight
restoration surgery1. Cataract affects all ages although age-related
cataract is more prevalent in the elderly. This disease occurs equally in both
males and females without any sex predilection. Many cataract blind patients
reside in underserved communities.
Surgery
is, for now, the confident method of restoring vision in the cataract blind.
Cataract surgery with intraocular lens implant ensures better post-operative visual rehabilitation. For fear of severe complications such as
endophthalmitis, it is often advised that cataract surgery be performed on a
uniocular basis.2,3 The 2011 American Academy of Ophthalmology
preferred practice pattern of cataract in an adult eye further cautioned that
where it is intended to perform bilateral simultaneous cataract surgery, the
pros and cons of the procedure should be carefully discussed with the patient.2
Indeed bilateral simultaneous
cataract surgery (BSCS) has been the subject of extensive
debates in developed countries where phacoemulsification via small clear
corneal incision is the standard surgical technique4-6
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Nevertheless, there may be many compelling reasons for
performing BSCS especially in developing countries. These include late
presentation of many patients with bilateral hypermature cataract, the
inability of many patients to afford both the direct and indirect costs of
prolonged hospital stay. In developing countries including Nigeria, health
facilities with capability of intraocular surgery are often located in the
urban areas far from the rural abode of many patients.
The Guinness Eye Center Onitsha is the only publicly-owned
eye hospital in Anambra State (population 4.1million by 2006 census). It offers
comprehensive eye care services including medical, surgical and optical care as
well as 24-hour emergency service. Elective surgeries are performed 4 days every
week. Although other private eye clinics exist, it has the highest
concentration of ophthalmic manpower and facilities in the State. It attends to
patients from all over Nigeria and beyond although its immediate catchment area
is Anambra and the adjoining states.
The present study is a retrospective comparison of outcome
of unilateral versus bilateral simultaneous cataract surgery at the Guinness
Eye Center Onitsha, Nigeria over a 2-year period.
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