Comm Eye Health Vol. 15 No. 42 2002 pp 28 - 29. Published online 01 June 2002.

Early results of cataract surgery at Mechi Eye Care Centre in Nepal

Sanjay Kumar Singh MD

Ophthalmologist In-charge

Tulasi Dahal

Ophthalmic Assistant

Divya Sharma

Ophthalmic Assistant

Mechi Eye Care Centre, Post Box No 3, Jhapa, Nepal

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Mechi zone is located in the eastern region of Nepal and has a population of 1.2 million. According to the Nepal Blindness Survey in 19811 the prevalence of blindness in this zone was 0.64%. The most important cause of blindness in Nepal was cataract, accounting for two thirds of Nepal’s blindness.

The people of the eastern region of Nepal had to go either to the neighbouring zone or across the border to India for detailed ocular examination and intraocular surgery. Since the Mechi Eye Care Centre was established, on 1 December 1996, it has provided the facilities for ocular examination and for surgery. Cataract surgery is the main operation performed in the Centre. In this study we included the total cataract operations performed in our Centre during the period 1 December 1996 to 15 May 1998. We have not included the data of cataract operations carried out as part of the outreach activities of the Mechi Eye Care Centre.

Spectacles after cataract surgery. © Pak Sang Lee
Spectacles after cataract surgery. © Pak Sang Lee

Patients, surgery and follow-up

A total of 783 eyes were operated on in this period (Table 1). The ratio of male (50.4%) to female (49.6%) was nearly equal. Operations were done on the right eye (49.4%) and on the left eye (50.6%). Ninety-six percent of the patients were Nepalese in origin, 3% were Indian and 1% were Bhutanese refugees.

Table 1. Cataract surgery on 783 eyes at Mechi Eye Centre

Male RE Male LE Female RE Female LE Total
Cataract extraction with PCIOL 178 182 170 185 715 (91.3%)
Cataract extraction with ACIOL 11 11 11 7 40 (5.1%)
Aphakia 10 3 7 8 28 (3.6%)
Total 199 (25.4%) 196 (25%) 188 (24%) 200 (25.5%) 783

The most common type of cataract was age-related cataract, most often a mature cataract (Table 2). As our Centre does not have the facility to provide general anaesthesia we could not operate on children with congenital cataract unless they were more than twelve years of age and able to cooperate.

Table 2. Cataract types presenting at Mechi Eye Centre

Type Numbers
Age-related cataract 1221 (94.7%)
Congenital 25 (1.9%)
Traumatic 21 (1.6%)
Complicated 13 (1%)
Dislocated lens 10 (0.8%)
Total 1290

Surgery was done under the Takagi OM-5 microscope. Extracapsular cataract extraction with posterior chamber intraocular lens implantation was the routine procedure. Sometimes, if indicated, we performed intracapsular cataract extraction with anterior chamber intraocular lens implantation. Lens implantation was done under air in the anterior chamber, however viscoelastics were used occasionally if the intraoperative IOP was high and there was difficulty with lens implantation. Suturing was done with 10/0 nylon sutures. Subconjunctival gentamicin was given only if there was conjunctival discharge or conjunctival congestion.

Post-operatively, patients were examined on the slit-lamp. On the first day they were examined by the ophthalmologist. Patients were discharged on the first post-operative day and were called after one week for follow-up. At their subsequent visit they were examined either by the oph halmologist or by the ophthalmic assistant. If any complication was noted then the ophthalmologist was notified immediately. Refraction was done every time at the first visit and where possible, thereafter.

Pre-operative and post-operative visual acuities

On the first post-operative day only 7.3% of the patients had presenting vision worse than 3/60 and 40% of the patients had vision equal to or better than 6/18. On the first return visit to hospital only 5.8% had presenting vision worse than 3/60 and with refractive correction only 0.2% were blind. With refractive correction nearly 91% of the patients had vision equal to or better than 6/18. There was a significant improvement in vision noted after surgery and minor refractive correction.

Causes of blindness after cataract surgery

The following are the causes of low, uncorrected vision after surgery, found on the first post-operative day. Aphakia was the important cause for the presenting, uncorrected vision to be less than 3/60. Other important causes were often due to posterior segment disorders present before the surgery.

ECCE versus ICCE

Both of the procedures have certain advantages and disadvantages. ECCE offers well-known advantages:2 low frequency of vitreous loss and cystoid macular oedema, but still the risk of opacification of the posterior capsule. Twenty-one percent of the patients had posterior capsular opacification at follow-up.3 Intracapsular cataract extraction is a reasonably successful, appropriate and cost-effective procedure. It is particularly suitable for treating the increasing number of blind cataract patients in areas of the world where resources are limited. 4,5,6 However, of 235 aphakic patients followed for 1-10 years in Karnali, Nepal only 23% were wearing aphakic spectacles in good condition, 25% had lost or broken their spectacles, 31% were wearing scratched or repaired spectacles, 5% never received spectacles and 16% were dissatisfied. 7

In Nepal, cataract is still the major cause of blindness. Some centres are carrying out extracapsular cataract extraction with posterior chamber intraocular lens implantation while other centres are doing intracapsular cataract extraction and prescribe spectacles afterwards. In our view, as the quality of vision is better with IOL implantation and intraocular lenses are available at cheaper prices, intraocular lens implantation is a cost-effective procedure after extracapsular or intracapsular cataract extraction.


Extracapsular cataract extraction with intraocular lens implantation is a procedure with less sight threatening and eye threatening complications, in the hands of an experienced surgeon. Technical expertise can be learned with practice. In our country where aphakic glasses are not easy to buy in many parts of the country, IOL implantation during cataract surgery in eye hospitals and eye centres is a better alternative to aphakic correction with spectacles.

Table 3. Visual acuities in 1374 eyes presenting with cataract

Visual Acuity Numbers
<3/60 1094 (79.6%)
>3/60 – 6/36 253 (18.4%)
>3/36 – 6/24 24 (1.7%)
>6/18 – 6/6 3 (0.2%)
Total 1374

Table 4. Post-operative uncorrected visual acuities in 783 patients receiving surgery

Visual acuity Day 1

Week 1 Month 1 Month 2
<3/60 57 (7.3%) 36 (5.8%) 11 (5%) 1 (2.1%)
3/60 – 6/60 95 (12.1%) 64 (10.2%) 12 (5.5%) 4 (8.3%)
6/36 – 6/24 297 (37.9%) 274 (43.8%) 90 (41.1%) 20 (41.7%)
6/18 – 6/6 313 (40%) 236 (37.7%) 102 (46.6%) 23 (47.9%)
Not mentioned 21 (2.7%) 16 (2.6%) 4 (1.8%)
Total 783 626 (79.9%) 219 (27.9%) 48 (6.1%)

Table 5. Post-operative corrected visual acuities in patients returning for follow-up

Visual acuity Week 1

Month 1 Month 2
<3/60 1 (0.2%)
3/60 – 6/60 7 (1.2%)
6/36 – 6/24 36 (6.3%) 2 (1%) 2 (5.1%)
6/18 – 6/6 515 (90.5%) 189 (97.4%) 36 (92.3%)
Not mentioned 10 (1.8%) 3 (1.6%) 1 (2.6%)
Total 569 194 39

Table 6. Causes of blindness after surgery (1st post-operative day)

Causes Numbers
‘Aphakia’ 16 (2%)
Posterior capsular opacity 4 (0.5%)
‘Poor fundal glow’

4 (0.5%)
Optic atrophy 3 (0.4%)
Retinal scar 3 (0.4%)
Corneal opacity 2 (0.3%)
Retinal detachment 2 (0.3%)
Phacomorphic glaucoma (previous) 2 (0.3%)
Posterior synechia 1 (0.1%)
Maculopathy 1 (0.1%)
Age-related macular degeneration 1 (0.1%)
Macular hole 1 (0.1%)
Retinal haemorrhage 1 (0.1%)
Total 57


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