Biomedical subjects
S Ruit
Publications and source records attributed to S Ruit.
An innovation in developing world cataract surgery: sutureless extracapsular cataract extraction with intraocular lens implantation.
PURPOSE: The benefits of sutureless cataract surgery have not been available to the majority of developing world patients. This report describes a surgical technique developed to gain the benefits of self-sealing sutureless techniques, without the need for costly, complex instrumentation, expensive consumables, or difficult nucleus fragmentation manoeuvres in the anterior chamber. METHOD: A detailed description of a sutureless technique that uses only standard manual extracapsular cataract extraction instrumentation is presented. The clinical records of 362 consecutive completed sutureless surgeries were reviewed, and preliminary indicative data of visual outcome for those having follow up between postoperative weeks 3 and 8 are also presented. RESULTS: Hospital and eye camp experience confirms this operation offers speed, routinely 5 min or less with mature cataracts, reduced cost because no suture, viscoelastic or anterior chamber maintainer is needed, wound security and stability, and rapid effective visual rehabilitation. Uncorrected distance visual acuity during the third to eighth postoperative week was available for 266 of the 362 patients (73%): 10, 145, 101, and 10 had acuities of better than 6/9, 6/9-6/18, 6/24-6/60, and worse than 6/60, respectively. Ninety-seven, 165, 12, and two of the 276 (76%) patients with recorded corrected distance acuity were in the same groups. Comparing postoperative with preoperative corneal astigmatism for each patient with postoperative information available (208), without regard to axis, the amplitude of astigmatism worsened by a mean of 0.94 dioptres (+/- 0.17, 95% confidence; +/- 1.23 standard deviation; 7.5D maximum worsening; 2.5D maximum improvement). No attempt has been made to analyse complication type or frequency in this preliminary report. CONCLUSION: The authors believe this sutureless cataract extraction technique to be an innovation with widespread application in the developing world. Further and more exhaustive critical appraisal is warranted.
Cataract intervention in the developing world: knock-on development through mentoring hospitals.
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Low-cost high-volume extracapsular cataract extraction with posterior chamber intraocular lens implantation in Nepal.
OBJECTIVE: To improve current clinical practices and ways of thinking about the problem of curable Third-World blindness resulting from cataract. DESIGN: A two-site prospective, nonrandomized, comparative clinical trial. PARTICIPANTS: Patients from 2 distinct surgical venues underwent cataract surgery following the same carefully outlined protocol: 62 consecutive cases from the Tilganga Eye Centre in Katmandu, Nepal, and 207 cases from a remote eye camp in rural Chaughada, Nepal. INTERVENTION: Extracapsular cataract extraction with posterior chamber intraocular lens (IOL) implantation surgery using a technique developed by Dr. Sanduk Ruit of the Tilganga Eye Centre in conjunction with the Medical Directorate of the Fred Hollows Foundation of Australia. Also presented is the teaching method used to help make local doctors proficient in this technique. MAIN OUTCOME MEASURES: Visual acuity recorded at 2 months after surgery as well as surgical complications. RESULTS: Preoperative visual acuities for the 62 patients from the Tilganga Eye Centre ranged from 20/60 to light perception only (4 patients were untested). At 2 months after surgery, 87.1% had a best-corrected visual acuity of 20/60 or better. There were zero major surgical complications reported from the Tilganga group. Of the 207 patients at the Chaughada eye camp, preoperative visual acuities (recorded for 177 [85.5%]) ranged from 20/200 or greater to light perception only. One hundred eighty-nine (91.3%) of the patients returned for an examination at 2 months after surgery, at which time 54.5% had an uncorrected visual acuity of 20/60 or greater, improving to 74.1% with correction. There were six (2.9%) surgical complications documented at Chaughada. CONCLUSIONS: Because the average operative time using the technique presented here is less than 10 minutes per case and the cost per surgery is less than $20, the surgical results are significant in addressing the massive problem of cataract blindness in the Third World. With some changes in preoperative care, a simplified surgical technique, the development of local lens factories, and the implementation of teaching programs, effective lens implantation cataract surgery can be done in high volume at affordable costs in remote areas of underserved nations.
Modern surgery for global cataract blindness: preliminary considerations.
Unoperated cataract in the developing world remains ophthalmology's major unsolved problem. Recent developments have brought into question the assumptions of those who have thought that extracapsular surgery with implantation of a posterior chamber intraocular lens is an unrealistic approach to the treatment of global cataract blindness. High-quality 1-piece posterior chamber intraocular lenses are being manufactured locally for approximately $10 each. Most ophthalmologists can be trained to perform extracapsular surgery in a 1-month course. This process is particularly effective if outstanding local surgeons receive intensive training to become instructors. While the incidence and treatment of posterior capsule opacification requires further study, the development of a low-cost YAG laser may be a solution. Imaginative ways to recover costs will need to be developed if the staggering prevalence of cataract blindness is to be effectively addressed. The improved result of modern surgery may make patients more willing to pay for their operation.
Extracapsular cataract extraction in Nepal. 2-year outcome.
We evaluated the 2-year outcome of extracapsular cataract surgery with posterior chamber intraocular lens insertion by a single fellowship-trained surgeon in Kathmandu, Nepal. Six hundred ten eyes were followed up for 2 years. Patients underwent manual irrigation and aspiration with the insertion of a modified J loop posterior chamber intraocular lens. Almost half of the patients had uncorrected visual acuities of 20/50 or better after surgery. Sight-threatening complications in seven eyes (1.2%) included retinal detachment, corneal decompensation, and endophthalmitis. Although this rate is comparable to that in developed countries, 21% of patients had posterior capsular opacification at follow-up. Extracapsular cataract surgery with intraocular lens insertion may be an alternative to intracapsular cataract surgery in developing nations, where aphakic spectacles are expensive, not easily obtainable, or difficult to replace.
Long-term results of extracapsular cataract extraction and posterior chamber intraocular lens insertion in Nepal.
We performed a prospective study evaluating the 2-year success rate of extracapsular cataract surgery and posterior chamber IOL insertion performed in 610 eyes by an experienced surgeon in the Nepal Eye Hospital, Kathmandu, Nepal. All patients were followed for 2 years. All eyes underwent manual irrigation and aspiration of cortical materials with the insertion of a modified J-loop posterior chamber IOL. Almost one half of eyes had final uncorrected visual acuities of 20/50 or better. Devastating complications, including retinal detachment, corneal decompensation, and endophthalmitis, occurred in 7 (1.2%) eyes. Extracapsular cataract surgery with IOL implantation appears to be a possible alternative in underdeveloped nations where the prevalence of cataract is high and aphakic spectacles are not easily obtained by poor patients and may be lost or broken. The procedure may improve the quality of vision, and therefore the quality of life, in those patients able to obtain pseudophakic vision.
On the practicalities of eye camp cataract extraction and intraocular lens implantation in Nepal.
Based on our experience in Nepal, we discuss the practicalities of performing extracapsular cataract extraction (ECCE) with intraocular lens (IOL) implantation in the context of the third-world eye camp. At slightly less than 30 minutes per case, while not as quick as an intracapsular cataract extraction (ICCE) with a Graefe section, the trade-off between vision result and operation time, according to patients, is very much in favor of the ECCE/IOL technique. Also, although IOLs remain expensive, by using donated lenses, the overall costs of providing ECCE/IOL surgery need not exceed those of providing ICCE.