RAJIV GANDHI UNIVERSITY OF HEALTH SCIENCESBANGALORE, KARNATAKA
ANNEXURE – II
PROFORMA FOR REGISTRATION OF SUBJECT FOR DISSERTATION
- NAME OF THE CANDIDATE & ADDRESS
- NAME OF THE INSTITUTION
- COURSE OF STUDY & SUBJECT
- DATE OF ADMISSION TO COURSE
- TITLE OF THE TOPIC
6) BRIEF RESUME OF THE INTENDED WORK:
6.1) NEED FOR THE STUDY:
Cataract is the leading cause of blindness in India1,2,3,4. Cataract surgical techniques have changed enormously in the last ten years, both in the developed world and in the developing world, and will undoubtedly continue to change at an ever-increasing rate. Phacoemulsification is now the standard, and almost the only procedure in the developed world. Its implication in the developing world is also increasing at a rapid rate. While it’s an expensive surgery, the presumed cost-effectiveness of phaco comes from its ability to return patients to work and to functioning lives much more quickly than conventional extra capsular extraction. Hence a need to analyse the feasibility and advantages of this technique over small incision cataract surgery in camp patients in our clinical setting is warranted.
6.2)REVIEW OF LITERATURE :D C Minassian,P Rosen,et alconducted a two centre randomized trial, 232 patients with age related cataract received ECCE, and 244 received small incision surgery by Phaco.Surgical complications and capsule opacity within 1 year after surgery were significantly less frequent, and a higher proportion achieved an unaided visual acuity of 6/9 or better (<0.2 log MAR) in the Phaco group. Postoperative astigmatism was more stable in Phaco.5
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Parikshit M.GogateSucheta R.Kulkarni conducted RCT in which a total of 400 eyes were assigned randomly to either phacoemulsification or small-incision groups. Both the phacoemulsification and the small-incision techniques were found to be safe and effective for visual rehabilitation of cataract patients, although phacoemulsification gave better uncorrected visual acuity in a larger proportion of patients at 6 weeks.6
Soon-Phaik Chee, Seng Ei Ti, et al conducted a randomized clinical trial. Patients having cataract surgery were randomized to receive ECCE (n = 16) orphacoemulsification(n = 18). Inflammation was assessed qualitatively by slit lamp grading of cells and flare and quantitatively using the Kowa flare meter. The combined slit lamp inflammatory scores (anterior chamber cells and flare) showed the ECCE group had significantly higher mean flare measurements than the phacoemulsificationgroup. Flare levels in the ECCE group returned to preoperative values by the second month; thephacoemulsificationgroup achieved preoperative levels by 1 month.7
Praveen R Mamidipudi, Abhay R Vasavada, et al conducted a prospective study comprising 300 patients who were evaluated preoperatively for visual acuity, Quality of life, Visual Function, and demographic information, postoperative evaluation, patient satisfaction, resumption of routine daily activities and professional work following phaco were also assessed. The speed of visual acuity recovery after phacoemulsification matched the improvement across health-related QoL functions, resulting in rapid recovery of the patients’ functional independence and health status.8
Liu j, Xu J, He M of Zhongshanof Ophthalmic Center, Sun Yat-sen University, Guangzhou, China studied 116 patients receiving Phacoemulsification. They were interviewed using the quality of life questionnaire, and the clinical outcomes were evaluated before surgery and at 1 week, 1 month, 3 months, and 6 months after surgery respectively.Patients receiving phacoemulsification reported rapid improvement in quality of life after surgery.9
Sheena A Dholakia, Abhay R Vasavadaconducted a prospective, observational study of 165 consecutive eyes undergoing phacoemulsification. Eyes were examined at 6 months and then yearly for 3 years. No serious intraocular complications occurred. Posterior Capsular Opacification rates and endothelial cell loss were acceptable. Consistent and reproducible outcome can be obtained after phacoemulsification of age related cataracts (grade I to III).10Civerchia L,Ravindran RD, et alconducted a prospective study in which out of the 83 patients who underwent phacoemulsification and IOL implantation, 59 (71%) attained vision of 6/12 or better with correction and 68 (79%) achieved vision of 6/18 or better with correction.10
In high volume surgery, the cost of cataract surgery by Phacoemulsification decreases as the numbers of surgeries increase.Rationalization of expenses, saving on non-critical components and above all vision and staff motivation and change in attitude will help a lot in making phacoemulsification the surgery of choice in camps in majority of cataract patients.12
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6.3)AIMS & OBJECTIVES OF THE STUDY:
1.To study the visual functionuptake of refraction after phacoemulsification and after small incision cataract surgery in camp patients.
2. To study theintra & post op complications of phacoemulsification and small incision cataract surgery in camp patients.
3. To study the early rehabilitation after phacoemulsification and after small incision cataract surgeryin camp patients.
7) MATERIALS AND METHODS :
7.1)SOURCE OF DATA:
The source of data is in a clinical setting comprising of urban and rural camp patients admitted to Minto Ophthalmic Hospital,Bangalore during the period from October 2010 to October 2012.
7.2)METHOD OF COLLECTION OF DATA :
It is a hospital based study of 50camp patients with cataract out of which 25 will be undergoing phacoemulsification surgery and 25, small incision cataract surgery. Cases will be studied in terms of visual acuity,refraction,intra & post-operative complications and rehabilitation.
Z test will be used for statistical analysis of the data.
INCLUSION CRITERIA
- All senile cataract (Adult onset cataract)
- Subluxated Lens
- Complicated Cataract
- Drug induced Cataract
- Immunocompromised states
- Cataract associated with posterior segment pathologies including Diabetic retinopathy & Hypertensive retinopathy
Yes, the study involves the following investigations and interventions on patients:
- Visual Acuity testing using Snellen’s Chart
- Slit-lamp examination
- Intraocular pressure measurement
- Biometry
- Indirect Ophthalmoscopic examination
- Contact B-scan Ultrasonography
Yes.
8) LIST OF REFERENCES:
8.1) TEXTBOOK REFERENCES:
1.Ramanjit Sihota & Radhika Tandon.Parson’s Disease of The Eye20th ed. Elsevier India, 2007 Ch. 18 pg 258-269.
2.Lucio Buratto & Maurizio Zanini:Phacoemulsification: Principles and Techniques 2nd ed. Slack Incorporated 2003.
3.Sunita Agarwal, Athiya Agarwal, Amar Agarwal. Phacoemulsification. 3rd ed.Taylor & Francis 2004
4.Jack J Kanski: Clinical Ophthalmology 6th edition 2007, Chapter 12 pg346-350.
8.2) JOURNAL REFERENCES:
5.Minassian DC, Rosen P, Dart JKG, Reidy A, Desai P, Sidhu M. Extra-capsular cataract extraction compared with small incision surgery by phacoemulsification: a randomized trial. Br J Ophth2001 85:822-829.
6.Gogate PM, Kulkarni SR, Krishnaiah S, Deshpande RD, Joshi SA, Palimkar A, et al.Safety and Efficacy of Phacoemulsification Compared with Manual Small-Incision Cataract Surgery by a Randomized Controlled Clinical Trial:Six-Week Results.Ophthalmology 2005:5:869-874.
7.CheeSP,Seng-EiTi,Sivakumar M, Donald TH.Postoperative inflammation: Extra capsular cataract extraction versusPhacoemulsification.J Cataract Refract Surg 1999Sep:25(9) 1280-1285.
8.Mamidipudi PR, Vasavada AR,Merchanta SV,Namboodiri VN,Ravilla TD. Quality-of-life and visual function assessment after phacoemulsification in an urban indian population. J Cataract Refract Surg 200329(6)1143-1151.
9.Liu J,Xu J,He M. The changes of quality of life in the patients after phacoemulsification with intraocular lens implantation. Yan Ke Xue Bao 2004: 20:135-9:
10.Dholakia SA& VasavadaAR. Intraoperative performance and long-term outcome of phacoemulsification in age-related cataract. Indian J Ophthalmol2004: 52; 311-7.
11.Civerchia L,Ravindran RD,Apoorvananda SW,Ramakrishnan R,Balent A,Spencer MH,et al. High-volume intraocular lens surgery in a rural eye camp in India. Ophthal Surg Lasers1996 Mar;27(3):200-10.
12.Sinha SK, Goel H, Sinha A, Tara A.Feasibility of phacoemulsification surgery in camp. Delhi ophthalmic society article2010.
9) SIGNATURE OF THE CANDIDATE :
Dr. NISHCHITHA.N
10) REMARKS OF THE GUIDE :
Phacoemulsification is now the state of art technique of standard care in cataract patients. The feasibility of this technique and its advantages over small incision cataract surgery in camp patients is to be analyzed.
11) NAME AND DESIGNATION OF
11.1) GUIDE :Prof. Dr. SUJATHA B.L.
MBBS, MS (Oph),MSc.CEH(London)FVR(RGUHS)
Professor,
Minto Ophthalmic Hospital & Regional
Institute of Ophthalmology
Bangalore Medical College & Research
Institute
Bangalore.
11.2)SIGNATURE OF THE GUIDE :
11.3) Co-guide (if any) :None
11.4) Signature of co-guide : Not Applicable
11.5) HEAD OF DEPARTMENT : Prof. Dr. RAVIPRAKASH
MBBS, MS(Ophthalmology)
Professor & HOD,
Minto Ophthalmic Hospital & Regional
Institute of Ophthalmology
Bangalore Medical College & Research
Institute
Bangalore.
11.6) SIGNATURE OF HOD :
11.7) DIRECTOR OF MINTO OPHTHALMIC HOSPITAL & REGIONAL INSTITUTE OF OPHTHALMOLOGY: Prof. Dr. SRIPRAKASH
MBBS, MS(Ophthalmology)
Director,
Minto Ophthalmic Hospital & Regional
Institute of Ophthalmology
Bangalore
11.8) SIGNATURE OF DIRECTOR :
12)DEAN & DIRECTOR : Prof. Dr. SUBHAS.G.T
Dean & Director,
Bangalore Medical College & Research
Institute
Bangalore.
12.1) REMARKS OF DEAN & DIRECTOR:
12.2)SIGNATURE OF DEAN & DIRECTOR:
1