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J Comm Eye Health 2001;14(38): 30
LETTERS TO THE EDITOR
Cataract Surgery
Dr Martin J Stagles |
Keywords: Cataract Extraction/methods;
Dear Editor
'Is there still a place for Intracapsular Cataract Extraction.?' (J Comm Eye Health 2000; 13: 62)
Thank you for bringing this subject up for discussion. During most of my time at Enongal Hospital, Cameroun, we were not equipped for extracapsular cataract extraction. A Lions Club team had been past before I arrived, brought a microscope with them, and did extracapsular cataract extractions with posterior chamber lens implants; a few of their patients did very well, but most did badly. The problems we noticed with these patients were mostly 'inflammatory' - pupil membranes and thickly opacified capsules, sometimes with displacement of the lens implant. Our general experience was that intracapsular cataract extraction was more reliable in giving moderately good results for most people.
Our colleagues at Acha Tugi in northwestern Cameroun routinely used extracapsular cataract extraction and reckoned to get good results - but they used huge doses of steroids that were not available at Enongal. They commented too that there seems to be a change as you go westwards across equatorial Africa: east African eyes generally react mildly to being operated on, but in Cameroun at least, eyes react very briskly. David Yorston from Kikuyu in Kenya has commented on a minority of patients there who have an unusually brisk inflammatory reaction after cataract surgery (Br J Ophthalmol 2001; 85: 267-71, and Br J Ophthalmol 1999; 83: 897-901), but patients of this sort seem to be the majority in Cameroun. We also noticed that glaucoma is common and aggressive in Cameroun, and that many patients have a lot of Tenon's capsule stuck down on the sclera. Might there be some local factor (genetic, perhaps?) which links these phenomena?
