To Study the Outcome of Cataract Surgery in a Rural Indian Population Which Primarily Depends on Camps and NGOs for a Free Cataract Surgery

BACKGROUND The present study was conducted as a rapid assessment of avoidable blindness survey by cluster sampling, aimed primarily to assess the outcome of cataract surgery in a rural Indian population. METHODS An Observational Point Prevalence study including 407 pseudophakic eyes of 382 subjects, screened through Survey across District in Rural Wardha and admitted in the eye ward of a Rural Tertiary Care Teaching Centre, who gave informed consent were included in this study. History of cataract surgery (time, place, cost and provision of glasses), diabetes mellitus, past history of laser capsulotomy was recorded. Visual acuity and thorough ocular examination including grading of PCO were done. Ocular findings were recorded on pre-tested proforma. RESULTS Prevalence of PCO among the pseudophakic eyes was 31.4%. Mean age of study population was 68.1 +/- 8.3 years (range 14-86 years). Rates of PCO are noted to be minimum (21.4%) in the age group 55 - 59 years and maximum (36.1%) in the age group 75 - 79 years. Mean duration since surgery in eyes with PCO among the total 407 pseudophakic eyes included in the study was 27.9 +/- 23.7 months (range 1 - 120 months), 14.9% eyes developed visually significant PCO in <12 months since surgery. Prevalence of PCO ranged from 14.9% in <12 months since surgery to 32.0% at <60 months since surgery (chi(2)=23.99, p<0.05). In the study group which included 5 (23.9%) eyes with a Foldable IOL, developed PCO as compared to 133 (34.5%) in the eyes implanted with PMMA IOL. Prevalence of PCO was higher in PMMA IOL. In the study group, 45 (59.2%) eyes with a Decentered IOL had PCO as compared to 93 (28.1%) eyes within the Bag placed IOL group. There was a higher prevalence of visually significant PCO in eyes with decentered IOL, as compared to eyes within the Bag IOL placement. (chi(2)=26.71, DF=1, p=0.00000). Out of 407 pseudophakic eyes included in the study, history of diabetes was noted in 14 persons, of whom 14 (3.4%) pseudophakic eyes were included in this study and 9 (64.3%) of these developed PCO. The prevalence of PCO was significantly higher among diabetic patients (chi(2)=4.65, p<0.05). The presence of uveitis in pseudophakic eyes was significantly related to higher PCO rates as compared to pseudophakic eyes without uveitis. (chi(2)=24.68, DF=1, p=0.000001). CONCLUSIONS Visually Significant PCO is seen in 1/3rd of eyes following cataract surgery. Duration since cataract surgery is a major factor influencing its genesis. IOL material, cataract surgery type, and IOL position are also important factors. Role of diabetes and uveitis needs to be studied further.