Læknablaðið - 15.06.1997, Blaðsíða 72

426
LÆKNABLAÐIÐ 1997; 83
A-l. Surgically induced astigmatism:
phacoemulsifícation by scleral tunnel in-
cision v/s phacoemulsification by clear
corneal incision
Shankar J, Gupta SR
From The Departinent of Ophthalmology, Inver-
clyde Royal Hospital, Greenock, Scotland
Introduction: The low potential for surgically
induced astigmatism with small incision cataract
surgery with implant is well accepted. The atten-
tion now shifts to minimising tissue handling and
need for decreasing operative time.
Material and methods: A prospective study was
conducted out on 47 cases of cataract managed
surgically by phacoemulsification with posterior
chamber intraocular lens implant. Twenty seven
consecutive patients underwent phacoemulsifica-
tion by scleral tunnel incision of which 20 qual-
ified for the study. The next 20 consecutive pa-
tients underwent phacoemulsification by corneal
section. Surgically induced astigmatism was esti-
mated at one week and eight weeks post-op.
Results: Although, the corneal section pro-
duced slightly higher astigmatism, there was no
statistical difference between the two groups. In
both groups, the mean surgically induced astig-
matism was less than one dioptre.
Discussion: The technique of phacoemulsifica-
tion by corneal section offers comparative surgi-
cally induced astigmatism as compared to scleral
tunnel and has the added advantage of avoiding
scleral cauterisation, availability of virgin con-
junctiva for future filtering surgery, if required
and less operative time. The corneal section is
particularly useful in patients who have under-
gone previous filtering surgery.
A-2. Day case cataract surgery in Fife.
Are domiciliary visits a safe and effective
practice?
Louise Willins, Barbara Grant, Patrick P Kearns
From The Department of Ophthalmology, Queen
Margaret Hospital, Dunfermline, Fife, Scotland
Introduction: In 1990 only 1% of cataract ex-
tractions were performed as day cases in Scot-
land. A Governmental Study Group recommend-
ed that this should rise to 30% by the end of 1993
and 80% by the end of 1997.
In Fife we have reached 69% by the end of 1996
by the introduction of domiciliary visits by trained
nurses on the first post-operative day rather than
the patients returning to hospital.
To determine whether this is a safe and effec-
tive practice we audited all day case cataract pa-
tients from January to December 1996.
Material and methods: Audit forms were as-
signed to each patient attending for day case cat-
aract surgery. These were used to collect data
from the day of operation, the domiciliary visit
and each subsequent out or inpatient visit to the
hospital until discharge or three months.
Results: Three hundred and three patients had
day case cataract surgery in 1996. Two hundred
eighty one forms were available to audit.
Two hundred twenty nine (80%) patients were
problem-free at their domiciliary visit and 51
(18.2%) patients required additional treatment at
this visit. One patient self-referred overnight.
Of the problem-free group 12 self-referred be-
fore their two week appointments and eight were
found to have a problem at two weeks. Three
patients required re-admission, two with hypo-
pyons and one with an IOL haptic in the anterior
chamber.
Of the additional treatment group 12 (23.5%)
were referred back to the medical staff. Eight
required a second visit and three were re-admit-
ted (hypopyon, wound leak, haptic in AC).
We compared our overall results with the clin-
ical outcome figures from the National Cataract
Surgery Survey in 1993. Of our patients 90% get a
corrected visual acuity of 6/12 or better (v. 75%).
Discussion: No patients had an adverse out-
come related to pathology missed by our nurses at
the domiciliary visit.
Our day case cataract service is a safe and effec-
tive service.
A-3. Small incision cataract surgery and
the Anterior Chamber Maintainer
(ACM)
Chawla HB, Adams AD, Wright M
From The Royal Infirmary of Edinburgh, Edin-
burgh, Scotland
The anterior chamber maintainer (ACM) is an
undervalued device, doing for the anterior seg-
ment what the vitrectomy inflow does for the
posterior segment. It creates ideal condition for
closed micro-surgery. It allows the performance
of small incision cataract surgery, cataract extrac-
tion and in the bag lens implantation without the
need for visco-elastic. Pre- and post-operative
endothelial counting compares favourably with
that described for standard ECCE and phaco-
emulsification.
It thus offers a safe and low cost contribution to