Evaluation of postoperative refractive error correction after cataract surgery

PLoS One. 2021 Jun 17;16(6):e0252787. doi: 10.1371/journal.pone.0252787. eCollection 2021.

Abstract

Suboptimal cataract surgery outcomes remain a challenge in most developing countries. In Ghana, about 2 million people have been reported to be blind due to cataract with about 20% new cases being recorded yearly. The aim of this study was to evaluate postoperative correction of refractive errors after cataract surgery in a selected eye hospital in Ashanti Region, Ghana. This was a retrospective study where medical records of patients (aged 40-100) who reported to an eye hospital in Ghana from 2013-2018 were reviewed. Included in the study were patients aged ≥40 years and patients with complete records. Data on patient demographics, type of surgery, intra-ocular lens (PCIOL) power, availability of biometry, postoperative refraction outcomes, pre- and postoperative visual acuity were analyzed. Data of two hundred and thirteen eyes of 190 patients who met the inclusion criteria were analyzed. Descriptive analysis and Chi-square test were carried out to determine the mean, median, standard deviation and relevant associations. The mean ± SD age was 67.21±12.2 years (51.2% were females). Small Incision Cataract Surgery (99.5%) with 100% IOL implants was the main cataract surgery procedure in this study. Pre-operative biometry was performed for 38.9% of all patients on their first eye surgery and 41.5% for second eye surgeries. About 71% eyes in this study were blind (presenting VA<3/60) before surgery; 40.4% had post-operative VA <3/60. Pre-existing ocular comorbidities discovered post- surgery, attributed to suboptimal visual outcomes. More than half (55.3%) of patients did not undergo postoperative refraction due to loss to follow-up. Year of surgery (p = .017), follow up visits< 2months (p < .0001) and discovered comorbidity post-surgery (p = .035) were the factors significantly associated with postoperative refraction. Myopia and compound myopic astigmatism were the dominant refractive error outcomes. The timing of post-operative refraction had a significant effect on postoperative refraction done. These findings indicate a clinically meaningful significance between completion of postoperative care and postoperative refraction done. Consequently, with settings in most developing countries, where less biometry is done, it is appropriate that post-operative refractive services are encouraged and done earlier to enhance the patients' expectations while increasing cataract surgery patronage.

MeSH terms

  • Adult
  • Aged
  • Aged, 80 and over
  • Cataract / physiopathology
  • Cataract / prevention & control*
  • Cataract Extraction / methods*
  • Female
  • Ghana
  • Humans
  • Lens Implantation, Intraocular / methods
  • Male
  • Middle Aged
  • Outcome Assessment, Health Care / methods
  • Outcome Assessment, Health Care / statistics & numerical data*
  • Postoperative Period
  • Refraction, Ocular / physiology
  • Refractive Errors / physiopathology
  • Refractive Errors / prevention & control*
  • Refractive Surgical Procedures / methods*
  • Retrospective Studies
  • Visual Acuity / physiology

Grants and funding

The authors received no specific funding for this work. The commercial affiliation role in our study was with the conceptualization of the study, provided ideas for study design and data collection and helped with the manuscript editing [S.W], but did not have any additional role in the funding, project administration, data analysis, decision to publish, or preparation of the manuscript. The specific roles of these authors are articulated in the ‘author contributions’ section.