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      Cataract Surgery Audit at a Private Hospital in Saudi Arabia

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          Abstract

          Background:

          To assess the visual outcomes following cataract surgeries at a Private Eye Hospital in Riyadh, Saudi Arabia.

          Methods:

          This was a cohort study of cataract surgeries performed from January to June 2014. Preoperative data were collected on patient demographics presenting and best corrected distance visual acuity (BCVA) and ocular comorbidity. Data were also collected on the type of surgery, type of intraocular lens (IOLs) implanted, and complications. BCVA and refractive status at 6–8 weeks postoperatively were noted. The predictors of vision ≥6/18 were identified.

          Results:

          Four hundred eyes of 400 patients underwent cataract surgery. There were 235 (59%) males. Presenting preoperative vision was <6/60 in 52 (13%) eyes. There were 395 (99%) eyes that underwent IOL implantation following phacoemulsification and 4 eyes received a sulcus fixated IOL. A single piece aspheric IOL was implanted in 358 (90%) eyes and a toric IOL was implanted in 31 (8%) eyes. Postoperative BCVA was classified as a “good outcome” (≥6/18) in 320 (80%) and a “poor outcome” (<6/60) in 24 (6%) eyes. Young age (adjusted odds ratio (OR) = 0.97, P = 0.01), male (adjusted OR = 2.4, P = 0.002), and ocular co-morbidities (adjusted OR = 0.2, P < 0.001) were predictors of vision ≥6/18. Complications included a dropped nucleus and a posterior capsular tear in 2 eyes each. Two hundred and fifty-two (63%) eyes were emmetropic or intentionally myopic for distance. Astigmatism <2 D was present in 264 (66%) eyes and astigmatism >2 D was present in 33 (8%) eyes.

          Conclusion:

          The recent trend of intentional overcorrection in one eye following modern cataract surgery in order to provide some functional near vision indicates that benchmark for success in getting “good visual outcomes” postoperatively (vision of ≥6/18) may need to be revised.

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          Most cited references24

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          Safety and efficacy of phacoemulsification compared with manual small-incision cataract surgery by a randomized controlled clinical trial: six-week results.

          To compare the efficacy, safety, and refractive errors of astigmatism after cataract surgery by phacoemulsification and manual small-incision cataract surgery techniques. Masked randomized control clinical trial. Four hundred eyes of 400 patients, 1:1 randomization with half in each arm of the trial. A total of 400 eyes was assigned randomly to either phacoemulsification or small-incision groups after informed consent and were operated on by 4 surgeons. They were masked to the technique of surgery before, during, and after cataract surgery and followed up to 1 year after surgery. The intraoperative and postoperative complications, uncorrected and best-corrected visual acuity, and astigmatism were recorded at 1 and 6 weeks postoperatively. The proportion of patients achieving visual acuity better than or equal to 6/18 with and without spectacles after cataract surgery in the operated eye up to 6 weeks, postoperative astigmatism, and complications during and after surgery. This article reports clinical outcomes up to 6 weeks. Three hundred eighty-three of 400 (95.75%) patients completed the 1-week follow-up, and 372 of 400 (93%) patients completed the 6-week follow-up. One hundred thirty-one of 192 (68.2%) patients in the phacoemulsification group and 117 of 191 (61.25%) patients in the small-incision group had uncorrected visual acuity better than or equal to 6/18 at 1 week (P = 0.153). One hundred fifty of 185 (81.08%) patients of the phacoemulsification group and 133 of 187 (71.1%) patients of the small-incision group (P = 0.038) were better than or equal to 6/18 at the 6-week follow-up for presenting visual activity. Visual acuity improved to > or = 6/18 with best correction in 182 of 185 patients (98.4%) and 184 of 187 (98.4%) patients (P = 0.549), respectively. Poor outcome (postoperative visual acuity < 6/60) was noted in 1 of 185 (0.5%) in the phacoemulsification group and none in the small-incision group. The mode of astigmatism was 0.5 diopters (D) for the phacoemulsification group and 1.5 D for the small-incision group, and the average astigmatism was 1.1 D and 1.2 D, respectively. There was an intra-surgeon variation in astigmatism. The phacoemulsification group had 7 posterior capsular rents compared with 12 in the small-incision group, but the phacoemulsification group had more corneal edema on the first postoperative day. Both the phacoemulsification and the small-incision techniques are safe and effective for visual rehabilitation of cataract patients, although phacoemulsification gives better uncorrected visual acuity in a larger proportion of patients at 6 weeks.
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            Rapid assessment of avoidable blindness and diabetic retinopathy in Taif, Saudi Arabia.

            To estimate the prevalence of blindness, diabetes and diabetic retinopathy (DR) in Taif, Saudi Arabia using the Rapid Assessment of Avoidable Blindness (RAAB) framework. 66 clusters of 50 people aged ≥50 years were randomly selected. Participants underwent visual acuity measurement and examination by an ophthalmologist. DR among diabetic participants (previous diagnosis and/or random blood glucose >200 mg/dl) was assessed through dilated fundus examination by an ophthalmologist using a direct and indirect ophthalmoscope ('clinical examination') and dilated digital fundus photographs graded by a retinal specialist following the Scottish DR grading system ('reference standard'). 3052 (93%) out of 3300 eligible people were examined. The prevalence of blindness was 2.6% (95% CI 2.0% to 3.2%). Posterior segment diseases (44%) and cataract (41%) were the leading causes of blindness. The estimated prevalence of diabetes was 29.7% (28.1% to 31.4%), among whom the prevalence of DR was 36.8% (33.3% to 40.2%) and sight-threatening DR (STDR) was 17.5% (CI 15.1% to 20.0%). Agreement was good (κ>0.6) between the clinical examination and reference standard for any DR and STDR. There was a high prevalence of diabetes, DR and STDR. It was possible to assess diabetes and DR within RAAB but it increased the survey duration, cost and complexity.
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              Prevalence and causes of visual impairment among Saudi adults attending primary health care centers in northern Saudi Arabia

              BACKGROUND AND OBJECTIVES: Few studies have been conducted in Saudi Arabia to estimate the prevalence of visual impairment and its causes. The objective of this study was to estimate the prevalence of visual impairment, and identify its causes and associated factors among the adult population attending primary health care (PHC) centers in Aljouf province, in northern Saudi Arabia. DESIGN AND SETTING: A cross-sectional study during the year 2005 in PHC centers in Aljouf province in northern Saudi Arabia PATIENTS AND METHODS: A sample of 620 Saudi adults, of age 18 years and older, from the catchment area of the Aljouf PHC centers, were randomly selected through a multistage random sampling technique. Data were collected using a questionnaire about socioeconomic and related information and a visual acuity test was performed using the Snellen chart (E). Diagnosis was established according to World Health Organization (WHO) criteria. Visual impairment was categorized into blindness for a visual acuity of less than 3/60 (20/400, 0.05) in the better eye with the best correction and low vision for a best corrected visual acuity of less than 6/18 (20/60, 0.3) but not less than 3/60 (20/400, 0.05) in the better eye. Regression analysis was used to identify the predictors of visual impairment. RESULTS: Of 617 adult Saudis interviewed and examined, 269 (43.6%) were females. The mean (SD) age was 38.6 (16.2) years. The overall prevalence of visual impairment was 13.9% (95% CI: 11.4%-16.9%). The main medical causes of visual impairments were refractive errors (36.0%) followed by cataract (29.1%) and diabetic retinopathy (20.9%), and the least leading cause was glaucoma (5.8%). The most prominent determinants of visual impairment were age (P<.05), sex (P<.001), and a history of previous eye injury (P<.05). CONCLUSION: Prevalence of visual impairment in the study population from the Aljouf area is high. It is recommended that regular checks of visual acuity be conducted for all Saudis of age 50+ years, who attend the PHC centers.
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                Author and article information

                Journal
                Middle East Afr J Ophthalmol
                Middle East Afr J Ophthalmol
                MEAJO
                Middle East African Journal of Ophthalmology
                Medknow Publications & Media Pvt Ltd (India )
                0974-9233
                0975-1599
                Oct-Dec 2015
                : 22
                : 4
                : 502-507
                Affiliations
                [1 ]Department of Ophthalmology, Imam Mohammed bin Saud Islamic University College of Medicine, Riyadh, Saudi Arabia
                [2 ]Department of Ophthalmology, Specialised Medical Hospital, Riyadh, Saudi Arabia
                [3 ]Department of Research, King Khaled Eye Specialist Hospital, Riyadh, Saudi Arabia
                Author notes
                Corresponding Author: Dr. Rajiv Khandekar, Department of Research, King Khaled Eye Specialist Hospital, Riyadh, Saudi Arabia. E-mail: rajiv.khandekar@ 123456gmail.com
                Article
                MEAJO-22-502
                10.4103/0974-9233.167820
                4660540
                26692725
                31c9cf37-4b4a-470d-bbfc-784e6caad4a5
                Copyright: © Middle East African Journal of Ophthalmology

                This is an open access article distributed under the terms of the Creative Commons Attribution-NonCommercial-ShareAlike 3.0 License, which allows others to remix, tweak, and build upon the work non-commercially, as long as the author is credited and the new creations are licensed under the identical terms.

                History
                Categories
                Original Article

                Ophthalmology & Optometry
                cataract,intraocular lens implant,surgical audit,visual acuity
                Ophthalmology & Optometry
                cataract, intraocular lens implant, surgical audit, visual acuity

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