THE OUTCOMES OF CATARACT SURGERY AT UTHUMPHONPHISAI HOSPITAL,SISAKET
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Abstract
Cataract is a leading cause of blindness worldwide, particularly among the elderly. Surgery is the mainstay of treatment to effectively restore visual function. The two commonly used surgical techniques are phacoemulsification and extracapsular cataract extraction (ECCE), which differ in their outcomes and procedural complexity. This study aimed to compare visual outcomes and postoperative complications between phacoemulsification and ECCE cataract surgeries at Uthumphonphisai Hospital, Sisaket Province, during fiscal years 2021–2023. This was a retrospective analytic study that reviewed medical records of 224 patients who underwent cataract surgery. Visual acuity was assessed using logarithm of the minimum angle of resolution (logMAR) before surgery and at 1 week and 1 month postoperatively. The outcomes between ECCE and phacoemulsification groups were compared using the Friedman test, Mann–Whitney U test, and Chi-square test, with a significance level set at p < 0.05.
The results demonstrated a statistically significant improvement in median visual acuity (logMAR) from 1.60 (IQR 1.0–1.9) preoperatively to 0.33 (IQR 0.16–0.54) at 1 month postoperatively (Z = 12.789, p < 0.001, r = 0.855). Patients who underwent phacoemulsification showed significantly better postoperative visual outcomes than those who underwent ECCE at both 1 week and 1 month (p < 0.001). The most common complications were corneal edema (3.1%) and posterior capsule rupture (1.8%), with no serious complications such as endophthalmitis observed.
Both surgical techniques effectively restored vision, with phacoemulsification yielding significantly superior outcomes compared to ECCE. However, as this was a retrospective study without adjustment for confounding factors, the results should be interpreted with caution. Further prospective studies with long-term follow-up are recommended to confirm these findings and guide improvement of cataract surgery services in community hospitals.
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เนื้อหาและข้อมูล (เขียนข้อกำหนด)
References
กรมการแพทย์. (2565). แผนยุทธศาสตร์การผ่าตัดต้อกระจกแห่งชาติ พ.ศ. 2565–2569 (National Cataract Surgery Strategic Plan 2022–2026). กรุงเทพฯ: กรมการแพทย์ กระทรวงสาธารณสุข.
กรมอนามัย. (2560). รายงานสถานการณ์สุขภาพตาในผู้สูงอายุไทย. กรุงเทพฯ: กรมอนามัย กระทรวงสาธารณสุข.
ราชวิทยาลัยจักษุแพทย์แห่งประเทศไทย. (2565). รายงานทะเบียนต้อกระจกประจำปี 2565 (Cataract Registry Annual Report 2022). กรุงเทพฯ: ราชวิทยาลัยจักษุแพทย์แห่งประเทศไทย.
สำนักจักษุกรรม กรมการแพทย์. (2566). รายงานสถานการณ์สุขภาพตาในประเทศไทย พ.ศ. 2566 (Thailand Eye Health Survey 2023: Situation of Avoidable Blindness). นนทบุรี: กระทรวงสาธารณสุข.
สุวรรณี แสงมหาชัย, อุทัย เลาหวิเชียร, และทิพาภัทร์ โพธิ์ถวิล. (2562). การบริหารภาครัฐในมิติต่าง ๆ ของไทย. กรุงเทพฯ: สำนักพิมพ์มหาวิทยาลัยธรรมศาสตร์.
Abou-Gareeb, I., Lewallen, S., Bassett, K., & Courtright, P. (2001). Gender and blindness: A meta-analysis of population-based prevalence surveys. Ophthalmic Epidemiology, 8(1), 39–56.
American Academy of Ophthalmology. (2022). Cataract in the adult eye (BCSC 2022–2023, Section 11). San Francisco, CA: American Academy of Ophthalmology.
Ang, M., & Afshari, N. A. (2021). Cataract and cataract surgery: Comprehensive overview and recent advances. The Lancet, 398(10295), 1281–1292.
Bourne, R. R. A., Steinmetz, J. D., Flaxman, S., et al. (2017). Trends in prevalence of blindness and distance and near vision impairment over 30 years: An analysis for the Global Burden of Disease Study. The Lancet Global Health, 5(9), e888–e897.
Congdon, N., Friedman, D. S., & Lietman, T. (2004). Important causes of visual impairment in the world today. JAMA, 290(15), 2057–2060.
Department of Medical Services, Ministry of Public Health. (2020). National strategic plan for prevention of blindness in Thailand. Bangkok: Ministry of Public Health.
Ferris, F. L., Kassoff, A., Bresnick, G. H., & Bailey, I. (1982). New visual acuity charts for clinical research. American Journal of Ophthalmology, 94(1), 91–96.
GBD 2019 Blindness and Vision Impairment Collaborators. (2021). Causes of blindness and vision impairment in 2020 and trends over 30 years: Evaluating the prevalence of avoidable blindness. The Lancet Global Health, 9(2), e144–e160.
Gogate, P., Deshpande, M., Wormald, R., Deshpande, R., Kulkarni, S., & Deshpande, M. (2010). Extracapsular cataract surgery compared with manual small incision cataract surgery in community eye care setting in Western India: A randomized controlled trial. British Journal of Ophthalmology, 94(3), 321–325.
Khanna, R. C., Murthy, G. V. S., & Dandona, L. (2021). Long-term outcomes and quality-of-life improvement after cataract surgery in community settings. British Journal of Ophthalmology, 105(9), 1289–1294. https://doi.org/10.1136/bjophthalmol-2020-317239
Khanna, R. C., Murthy, G. V. S., & Krishnaiah, S. (2020). Cataract surgery outcomes in secondary and tertiary eye care centers in India: The Vision 2020 e-resource study. British Journal of Ophthalmology, 104(1), 41–46.
Kraff, M. C. (2014). Extracapsular cataract extraction. In F. A. Jakobiec (Ed.), Principles and practice of ophthalmology (pp. 1634–1642). Philadelphia, PA: Saunders.
Lange, C., Feltgen, N., Junker, B., Schulze-Bonsel, K., & Bach, M. (2009). Resolving the clinical acuity categories “hand motion” and “counting fingers” using the Freiburg Visual Acuity Test (FrACT). Graefe’s Archive for Clinical and Experimental Ophthalmology, 247(1), 137–142.
Limburg, H., Foster, A., & Gilbert, C. (2020). Cataract surgery coverage and barriers to uptake in low-resource settings: A systematic review. Ophthalmic Epidemiology, 27(5), 339–351. https://doi.org/10.1080/09286586.2020.1776821
Lundström, M., Barry, P., Henry, Y., Rosen, P., & Stenevi, U. (2013). Visual outcome after cataract surgery: Comparison of phacoemulsification and extracapsular cataract extraction in the Swedish National Cataract Register. Acta Ophthalmologica, 91(4), 359–363.
Marmamula, S., Keeffe, J. E., Raman, U., & Rao, G. N. (2013). Population-based cross-sectional study of barriers to utilization of refraction services in South India: Rapid Assessment of Refractive Errors (RARE) Study. BMJ Open, 3(1), e002550.
Murthy, G. V. S., Vashist, P., John, N., Pokharel, G., Ellwein, L. B., & Dandona, L. (2018). Improving cataract surgery outcomes in India: Findings from a six-year longitudinal study. Indian Journal of Ophthalmology, 66(6), 843–849.
Narendran, N., Jaycock, P., Johnston, R. L., Taylor, H., Adams, M., Tole, D. M., & Sparrow, J. M. (2009). The Cataract National Dataset electronic multicentre audit of 55,567 operations: Risk stratification for posterior capsule rupture and vitreous loss. Eye, 23(1), 31–37.
Olson, R. J. (2021). Phacoemulsification and intraocular lens implantation. Survey of Ophthalmology, 66(6), 890–907.
Pascolini, D., & Mariotti, S. P. (2012). Global estimates of visual impairment: 2010. British Journal of Ophthalmology, 96(5), 614–618.
Riaz, Y., de Silva, S. R., Evans, J. R., Foster, A., & Kuper, H. (2018). Manual small incision cataract surgery (MSICS) versus phacoemulsification for age-related cataract. Cochrane Database of Systematic Reviews, 10, CD008813. https://doi.org/10.1002/14651858.CD008813.pub2
Supachai, P., Wongpakaran, N., & Rojanapongpun, P. (2019). Visual outcomes and complications of cataract surgery in a tertiary care hospital in Northeastern Thailand. Journal of the Medical Association of Thailand, 102(7), 689–695.
Wong, T. Y., Loon, S. C., & Saw, S. M. (2009). The epidemiology of age related eye diseases in Asia. British Journal of Ophthalmology, 90(4), 506–511.
Wongwuticomjon, T., Kongsap, P., & Chaidaroon, W. (2017). Visual outcomes after cataract surgery in a regional hospital in Northern Thailand. Chiang Mai Medical Journal, 56(3), 215–222.
World Health Organization. (2019). World report on vision. Geneva: WHO.
World Health Organization. (2023). World report on vision: Progress and insights 2023. Geneva: WHO.
