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Marcia R. Mitsuhiro, Nivea N. Cavascan, Francisco S. Soares, Arnaud Araujo-Filho, Adriana Berezovsky, Sung S. Watanabe, Alisson V. Carvalho, Paulo Henrique A. Morales, Rubens Belfort, Jr., Solange R. Salomao; Cataract Surgery Complications in Low-Income Older Adults in Brazil: The São Paulo Eye Study. Invest. Ophthalmol. Vis. Sci. 2011;52(14):4731.
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The volume of modern cataract surgery in Brazil increased in the last decade due to government initiatives to improve access to this surgical procedure. However, post-operative visual outcomes had not achieved the desirable quality. The purpose of this study is to investigate cataract-surgery complications and their possible influence with final visual acuity in low-income older adults of São Paulo city, Brazil.
The São Paulo Eye Study (SPES) is a population-based cross-sectional study of urban, low-middle income residents 50 years and older of three districts of São Paulo city. The prevalence of cataract surgery was 6.28% (95% confidence interval [CI], 5.29% to 7.27%). Participants were queried as to the year and type of facility for previous cataract surgery. Surgical procedure and evidence of surgical complications were noted. Main outcome measures were type of surgical complication and its influence in presenting (PVA) and best-corrected visual acuity (BCVA).
A total of 4,224 eligible persons were enumerated and 3,678 (87.1%) were examined. Surgical complications were found in 119 (33.8%) among the 352 cataract-operated eyes, including 51 with normal/near normal visual acuity (BCVA>20/40). The most frequent complications were displaced pupil (13.7%) and posterior capsule rupture (12.3%). In 68 eyes with BCVA ≤20/40, the most frequent complications were 32 (47.1%) with posterior capsule rupture, 24 (35.3%) with displaced pupil, 10 (14.7%) with IOL iris capture, 9 (13.2%) with corneal decompensation, and 41 (60.3%) with other complications. Surgical complication was identified as the principal cause of visual impairment (BCVA ≤20/40) in 36 eyes (10.2%): 14 (39.0%) with posterior capsule opacification, 6 (16.7%) with corneal decompensation, 6 (16.7%) with cystoid macular edema, 6 (16.7%) with subluxated/dislocated IOL/IOL iris capture and 4 (11.1%) with posterior capsule rupture.
Cataract surgical complications were found in approximately one third of cataract-operated eyes in this population. Complications were the main cause of visual impairment in a considerable number of eyes with a substantial proportion with posterior capsule opacification that is a reversible cause of visual deficit. Greater emphasis is needed to ensuring surgical quality along with better surgical training and more intensive post-operative monitoring.
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