ORIGINAL ARTICLE

Intra-Operative and Immediate Post-Operative

Complications of Cataract Surgery in an Eye Camp

Asad Azeem Mirza¹, Saba Al-Khairy², Mazhar-ul-Hassan³, Shahid Azeem Mirza⁴, Saad Aslam⁵

Farnaz Siddique⁶

^1,2,3,5,6Department of Ophthalmology, Dow International Medical College, DUHS

⁴Department of Ophthalmology, Ghambat Institute of Medical Sciences

ABSTRACT

Purpose: To analyze the intra-operative and immediate post-operative complications in patients after cataract

surgery in an eye camp.

Study Design: Descriptive cross-sectional study.

Place and Duration of Study: The study was conducted in a village of Nawabshah, Sindh, Pakistan from 7^thto

9^thof February 2020.

Material and Methods: Fifteen hundred patients were screened for visual disabilities of which 150 were selected

for the study. They had a visual acuity of less than 6/9 in one or both eyes and had a cataract. The selected

patients were operated using either phacoemulsification, extracapsular cataract extraction ECCE), intracapsular

cataract extraction (ICCE) or small incision cataract surgery (SICS). The immediate intra-operative as well as

post-operative complications on day 1 after surgery were observed.

Results: One hundred and fifty patients were operated. Age ranged from 14 years to 90 years, males were

58.7% and females were 41.3%. The most common procedure performed was phacoemulsification 51.3%,

followed by ECCE 30.0%, then SICS 18.0% and ICCE 0.7%. The most common intra-operative complication was

posterior capsule rent and the most common post-operative complication was striate keratopathy which was seen

in 14.0% individuals. There was a significant association found for post-operative complications with gender with

females having more post-operative complications as compared to males (P-value = 0.001 < 0.001).

Conclusion: Camp surgeries when performed with strict sterilization and in experienced hands can play an

important role in treating cataract, which is the commonest cause of preventable blindness in developing

countries.

Key Words: Cataract, Intra-ocular lens, Phacoemulsification, Extra Capsular Cataract Extraction, Corneal

Edema.

How to Cite this Article: Mirza AA, Al-Khairy S, Hassan M, Mirza SA, Aslam S, Siddique F. Intra-operative and

immediate post-operative complications in patients after cataract surgery in an eye camp. Pak J Ophthalmol.

2020; 36 (3): 226-230.

Doi: 10.36351/pjo.v36i3.1056

Pakistan, 1.12 million were blind with their visual

acuity less than 3/60, another 1.09 million [0.93 –

INTRODUCTION

According to a study out of 207.7 million people in

1.24] people were found to have severe vision loss

____________________________________________

(3/60 ≤ VA < 6/60) and another 6.79 million [6.00–

Correspondence to: Asad Azeem Mirza

7.74] people had moderate vision loss (6/60 ≤ VA <

6/18)¹. Muhammed Saleh Memon organized the first

national survey which was held between 1987–1990²

to determine the prevalence and causes of blindness in

Dow International Medical College, DUHS

Email: asad_azim@hotmail.com

Received: April 23, 2020

Accepted: May 4, 2020

Revised: May 4, 2020

226

Pakistan Journal of Ophthalmology, 2020, Vol. 36 (3): 226-230

Intra-Operative and Immediate Post-Operative Complications in Patients after Cataract Surgery in an Eye Camp

Pakistan. A total of 29,157 subjects from all over

recorded during surgery and these patients were seen

on post-operative day 1 and their ocular findings were

recorded.

Pakistan were examined and the declared prevalence

of blind people was 9.03%. There were varied causes

of decreased vision but the most common was found to

be due to cataract (66.7%). There was a study

conducted between 2002 – 2004 and the analyzed data

was published in two papers by Dineen et al.³and

Jadoon et al⁴.

The data was analyzed on IBM SPSS version 21.0

and the results were presented as mean ± standard

deviation for age, frequency, and percentages for

comorbids, gender, type of surgery, intra operative

complications and post-operative complications.

Statistical association were performed between post-

operative complication with age, comorbids, gender,

type of surgery using chi-square and fisher’s exact test.

A p-value of 0.05 or less was considered statistically

significant.

There is a serious lack of access to health care

facilities in rural areas of Pakistan predominantly due

to lack of resources and technical infrastructure

combined with reluctance of doctors and other health

care personnel to work in these poorly developed

areas. The main reason behind this is poor allocation

of funds and resources to the health sector of

Pakistan.^5,6

RESULTS

Total 150 subjects were analyzed. Table 1 describes

the descriptive statistics of all respondents. Mean age

was 68.5 ± 11.1 years. Males were 88 (58.7%) and

In order to provide health facilities to the people in

far flung areas, camps are organized in many

developing countries.^7,8The objective of our research

was to perform different types of cataract surgeries

feasible in low income countries and to document the

intra-operative and post-operative complications so as

to prevent them in future by taking appropriate

measures.

Table 1: Descriptive Statistics for Demographics.

Characteristics

N = 150 (%)

68.5 ± 11.1

Age in years (Mean ± SD)

Gender

MATERIAL AND METHODS

Male

88 (58.7%)

62 (41.3%)

This study was conducted over a 3-day period at an

eye camp located in Nawabshah, Sindh Pakistan.

Patients of all ages were screened for cataract in OPD

in the morning hours from 9:00 am till 1:00 pm while

surgeries were performed from 2:00 pm till 12:00 am.

There was a total of 150 patients selected for cataract

surgery. These patients underwent visual acuity

assessment and examination of anterior segment and

posterior segment. Patients with Diabetic retinopathy,

Age related macular degeneration, corneal opacity,

Female

Comorbid

None

135 (90%)

12 (8%)

HTN

02 (1.3%)

01 (0.7%)

Both

Type of Surgery

advanced

glaucoma,

conjunctivitis,

corneal

Phaco

77 (51.3%)

45 (30.0%)

27 (18.0%)

01 (0.7%)

02 (1.3%)

degenerations and dystrophies, macular scars were all

excluded from the study.

ECCE

The selected patients were then assessed for

uncontrolled Diabetes through a blood test for random

blood glucose, high blood pressure and blood test for

Hepatitis B, Hepatitis C and HIV viruses. Those found

to be positive for any of the above were excluded from

the study. These patients underwent one of the four

procedures phacoemulsification, extracapsular cataract

extraction, intracapsular cataract extraction and small

incision cataract surgery by four experienced qualified

eye surgeons. Any intra-operative complication was

SICS

ICCE

Intra-Operative Complications

Post-Operative Complications

None

124 (82.7%)

21 (14.0%)

Corneal edema

Pakistan Journal of Ophthalmology, 2020, Vol. 36 (3): 226-230

227

Asad Azeem Mirza, et al

surgery. There were 12 (8%) patients with DM, 02

(1.3%) patients with HTN and one having both

Diabetes and Hypertension. There was a significant

association of diabetics with postoperative corneal

edema.

Endophthalmitis

Iris prolapse

Others

01 (0.7%)

03 (2.0%)

Post-operative complications were significantly

related with gender, age and diabetes (Table 2).

females were 62 (41.3%). Majority of the patients had

no comorbidity i.e. 135 (90%) and few had Diabetes

Mellitus i.e. 12 (8.0%). Most common surgery

performed was phacoemulsification 77 (51.3%)

followed by ECCE 45 (30.0%) and SICS 27 (18.0%).

Regarding postoperative complications 124 patients

were observed to have none while 21 (14.0%) were

found to have corneal edema making it the most

common postoperative complication.

DISCUSSION

We reported results of an eye camp that was held in a

village where around 150 patients were operated for

cataract. Since cataract is the leading cause of

blindness worldwide, a similar study was done in

Pakistan where cataract was found in 66% of patients.²

Our study was aimed to analyze intra-operative and

post-operative complications occurring due to cataract

surgery. Most common procedure performed

worldwide is Phacoemulsification followed by

Table 2 describes association of post-operative

complication with age, comorbids, gender, type of

ECCE, SICS and ICCE. Rates of complications

Table 2: Association of Post-Operative Complications with

in both males and females differ and so does the

presence of comorbidities leading to increased

complication rate.

Demographics.

Post-Operative Complications

Striate Keratopathy (or Corneal Edema)

was the most common post-operative

complication observed in our study. This was

consistent with another study done in a rural

population in India.^9,10

Corneal

Edema

(n=26)

Characteristics

P-value

None

(n=124)

Total

(n=150)

Age (years)

10 - < 40

40 - < 70

≥ 70

02 (66.7%)

63 (90%)

01 (33.3%)

07 (10.0%)

18 (23.4%)

0.04*^

Overall, 40% of patients with comorbidities

developed corneal edema. Many studies have

also reported higher rates of endothelial loss

and edema among diabetic patients, factor

leading to delayed visual recovery.^11,12Diabetic

corneas do not recover as quickly as in normal

persons because of the decreased regulation of

fluid balance, enzymatic dysfunction of

bicarbonate pump and involvement of aldose

reductase with buildup of sorbitol in the corneal

stroma. Corneal edema was found in our

patients as we examined them both intra-

operatively as well as post-operatively and on

day 1 of surgery as well while Shakya K et al,

also reported the presence of corneal edema

even after 1 week post-operatively in diabetic

patients.¹³Yang R et al, also reported that

corneal endothelium in diabetic patients was

59 (76.6%)

Gender

Male

79 (89.8%)

45 (72.6%)

09 (10.2%)

17 (27.4%)

0.001**

0.02*^

Female

Comorbid

None

115 (85.2%) 20 (14.8%)

135

DM/HTN/Both

Type of Surgery

Phaco

09 (60.0%)

06 (40.0%)

62 (80.5%)

41 (91.1%)

21 (75.0%)

15 (19.5%)

04 (8.9%)

07 (25.0%)

0.10`

ECCE

SICS

prone

damage

from

**Significant at 1%, *Significant at 5%, `Chi-square Test, ^Fisher's

Exact Test

DM = Diabetes Mellitus, HTN = Hypertension

phacoemulsification.¹⁴

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Pakistan Journal of Ophthalmology, 2020, Vol. 36 (3): 226-230

Intra-Operative and Immediate Post-Operative Complications in Patients after Cataract Surgery in an Eye Camp

However, based on demographics, it can be noted

CONCLUSION

that increased age and female patients were more

likely to develop corneal edema. A study done by

Hashemi H et al, in Iran, highlighted the importance of

demographics and development of outcomes of

cataract surgery which showed females to be at a

disadvantage, lower level of education and older age

being the factors leading to post-operative

complications.¹⁵Similar are the conditions in Pakistan

where lack of resources predominantly in rural areas

along with the lack of health care access for patients

leads to comorbidities.¹⁶

Camp surgeries when performed with strict

sterilization and in experienced hands can play an

important role in treating cataract, which is the

commonest cause of preventable blindness in

developing countries.

Ethical Approval

The study was approved by the Institutional

review board/Ethical review board.

For several years, phacoemulsification has been

the method of choice for cataract extraction in

developed countries. But Phaco is far more dependent

on technology than the conventional extracapsular

cataract extraction (ECCE). Therefore, it is scrutinized

whether Phaco is worth the cost especially in low-

middle income countries like Pakistan. As reported by

Ruit et al, in a randomized control trial in Nepal on the

efficacy of Phacoemulsification vs. manual small-

incision extra-capsular cataract surgery (MSICS)

where they also compared the cost effectiveness of

both the procedures.¹⁷Results found that MICS was

not only cost effective but also a well-suited option

with excellent results in developing world where

prevalence of cataract was the leading cause of

blindness.

Conflict of Interest

Authors declared no conflict of interest.

Authors‘ Designation and Contribution

Asad Azeem Mirza; Assistant Professor: Research

Planning & Data Collection.

Saba Al-Khairy; Assistant Professor: Manuscript

Writing & Manuscript Drafting.

Mazhar-ul-Hassan; Professor & Chairman: Research

Design, Final Manuscript Review & Data Analysis.

Shahid Azeem Mirza; Professor: Research Planning &

Data Collection.

Saad Aslam; House Officer: Manuscript Writing &

Literature Search.

In our study we employed all three techniques

which best suited the patients. Rate of post-operative

corneal edema was less in ECCE as compared to

Phaco. There were more patients who had

phacoemulsification than ECCE or SICS but since

factors such as the presence of comorbidities and other

demographics contributed towards the development of

post-operative complications in phacoemulsification.

Farnaz Siddique; Associate Professor: Manuscript

Review.

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