Letters. Cataract surgery
I refer to the above subject that was brought up by Dr John Sandford-Smith in the Journal of Community Eye Health (J Comm Eye Health 2000; 13: 62).
The recommendations given for promoting ECCE with IOL implants are good, depending where you are and who is doing the surgery. In Africa, where eye services are poor or almost non-existent, this recommendation seems less appropriate. The recommendations given are more suitable for developed countries outside Africa. One question we should ask ourselves is why couching is so popular in Northern Nigeria. The answer is simple. Couching is a simple procedure, done in a convenient setting, by trusted (traditional) healers, with visual benefits. I am not supporting couching, but trying to point out that intracapsular cataract extraction should still be recommended in underdeveloped countries, especially in rural areas. We can learn from patients’ motivation in accepting couching, to educate people in utilizing available eye services in their community. For many in Africa, this will mean getting a safe ICCE done in a rural setting by a non-ophthalmologist, where an operating microscope and a YAG laser are still years away. I feel that ICCE should not be relegated to the history books.
After some years of doing ECCEs at our hospital, we have found that many of those who underwent ECCE have developed blindness again due to the opacification of the posterior capsule; this has damaged the reputation of the Blindness Prevention Programme in the community. Blind people and relatives feel cheated by the outcome a few years after surgery. This is now being dealt with by resuming ICCEs with anterior chamber IOLs.
However, I am not against the recommendation for ECCE with IOL implants, but agree with Dr John Sandford-Smith’s suggestion not to condemn ICCE with anterior chamber lens implants until a good audit and a retrospective analysis has shown that the results of ICCE are significantly inferior to ECCE in situations where YAG lasers and top quality microscopes may not be available.
One more point. If ECCE surgery is really the way to go in rural Africa, then my appeal is to the donor agencies to train the available ophthalmic personnel in ECCE techniques with lens implants and the use of the YAG laser, and then equip them with the instruments in question. This will then be a big jump forward in ophthalmology for Africa, one to which I am very much looking forward.