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Fulltext Cost Effectiveness Analysis Using Disability-Adjusted Life Years for Cataract Surgery

Rochmah TN, Wulandari A, Dahlui M, Ernawaty, Wulandari RD

Int J Environ Res Public Health, 2020 08 18;17(16).
PMID: 32824872 DOI: 10.3390/ijerph17166010

Cataracts are the second most prioritized eye disease in the world. Cataracts are an expensive treatment because surgery is the only method that can treat the disease. This study aims to analyze the cost effectiveness of each operating procedure. Specifically, phacoemulsification and Small Incision Cataract Surgery (SICS) with Disability-Adjusted Life Years (DALYs) as the effectiveness indicator is used. This study is an observational analytic study with a prospective framework. The sample size is 130 patients who have undergone phacoemulsification and 25 patients who have undergone SICS. The DALY for phacoemulsification at Day-7 (D-7) is 0.3204, and at Day-21 (D-21), it is 0.3204, while the DALY for SICS at D-7 is 0.3060, and at D-21, it is 0.3158. The incremental cost effectiveness ratio (ICER) for cataract surgery at D-7 is USD $1872.49, and at D-21, it is USD $5861.71, whereas the Indonesian Gross Domestic Product (GDP) is USD $4174.90. In conclusion, the phacoemulsification technique is more cost effective than the SICS technique. The ICER value is very cost effective at D-7 post-surgery compared to at D-21 post-surgery because the ICER is less than 1 GDP per capita per DALY.

Matched MeSH terms: Cataract Extraction/methods*
Trends and complications of local anaesthesia in cataract surgery: an 8-year analysis of 12 992 patients

Thevi T, Godinho MA

Br J Ophthalmol, 2016 Dec;100(12):1708-1713.
PMID: 26994109 DOI: 10.1136/bjophthalmol-2015-307785

BACKGROUND: Cataract surgery has progressed from large incision to smaller incisions, which do not require sutures. Anaesthesia too has progressed from general anaesthesia to local anaesthesia to topical anaesthesia. The ideal anaesthesia for cataract surgery would be one that is easy to administer, provides adequate pain relief during surgery and is associated with fewer complications.
AIMS: This study was done to find out the most suitable anaesthesia for patients with fewer complications and also to look at the trend of anaesthesia being used.
METHODS: A retrospective analysis was done of patients who underwent cataract surgery from 2007 to 2014 in Hospital Melaka. Data were obtained from the National Eye Database and analysed using SPSS. Trend of types of anaesthesia used and the associated complications with each were studied.
RESULTS: The most frequently used anaesthesia was topical anaesthesia, which showed an upward trend followed by subtenon in turn showing a downward trend. Subtenon anaesthesia was associated with more intraoperative and postoperative complications while topical anaesthesia was associated with fewer complications.
CONCLUSIONS: Topical anaesthesia has shown a steady increase in usage and is the ideal anaesthesia, which has been associated with fewer complications.

Matched MeSH terms: Cataract Extraction/methods*
The effectiveness of sub-Tenon's infiltration of local anaesthesia for cataract surgery

Verghese I, Sivaraj R, Lai YK

Aust N Z J Ophthalmol, 1996 May;24(2):117-20.
PMID: 9199741

PURPOSE: To determine if adequate anesthesia and akinesia could be obtained using an inferonasal quadrant sub-Tenons anaesthesia for cataract surgery.
METHODS: The sub-Tenons method of local anaesthesia was used in 50 patients undergoing extracapsular cataract extraction and lens implantation. The technique following was that described by JD Stevens in his study of 50 patients. Posterior sub-Tenons space was approached through a conjunctival incision in the inferonasal quadrant and the anaesthetic solution delivered by an irrigating cannula. The patients were assessed for residual ocular movements just before surgery. Effectiveness of anaesthesia was assessed during surgery using a verbal pain rating score. Scoring was based on the concept of a visual analogue pain score chart.
RESULTS: Total akinesia was obtained in 20% patients and total anaesthesia in 24% patients. The remainder of the patients had adequate akinesia and anaesthesia to proceed with and complete the surgery.
CONCLUSION: This method provides satisfactory anaesthesia for cataract surgery.

Matched MeSH terms: Cataract Extraction/methods*
The Malaysian Cataract Surgery Registry: Profile of Patients Presenting for Cataract Surgery

Salowi MA, Goh PP, Lee MY, Adnan TH, Ismail M

Asia Pac J Ophthalmol (Phila), 2015;4(4):191-6.
PMID: 26172075 DOI: 10.1097/APO.0000000000000068

PURPOSE: To investigate the change in the profile of patients who had cataract surgery at Ministry of Health (MOH) hospitals in Malaysia.
DESIGN: Secondary analysis on Malaysian Cataract Surgery Registry data.
METHODS: The Malaysian Cataract Surgery Registry, a MOH-initiated registry, collects data on patients who had cataract surgery at the 36 MOH ophthalmology departments including demography, causes of cataract, systemic and ocular comorbidity, preoperative visual acuity (VA), operative details, and postoperative outcomes. This article reviews data on patient profiles from 2002 to 2004 and 2007 to 2011.
RESULTS: The coverage of cataract surgery was 91.5% (171,482/185,388). Mean patient age was 64.5 years, and 51.6% were women. A high proportion of patients had hypertension (48.9%), diabetes mellitus (37.1%), and diabetic retinopathy (10.7%). Most had senile cataract (93.4%) and one third had second eye surgery. Most patients (82.0%) had preoperative unaided VA of worse than 6/12. Eyes presenting with unaided VA of worse than 3/60 decreased from 62.6% in 2002 to 47.7% in 2011, whereas those with 6/18 to 3/60 increased from 35.2% to 48.5% (P < 0.001). Patients who had extracapsular cataract extraction had worse preoperative VA than those who had phacoemulsification (81.3% vs 40% had vision worse than 3/60).
CONCLUSIONS: The obvious change in patient profiles was the decreasing number of eyes presenting with worse than 3/60 vision. Compared with developed countries, patients who had cataract surgery at MOH hospitals in Malaysia were younger and had higher associations with diabetes mellitus and diabetic retinopathy.

Matched MeSH terms: Cataract Extraction/methods