Optimizing Outcome of Cataract Surgery in Resource Scarce Sub-Saharan Africa

Background: Sub-Saharan Africa disproportionately accounts for high number of avoid- ably blind largely caused by cataracts. The blindness burden: Limitation in human and material resource for delivery of cata- ract surgical services, cost, gender, distance to hospital, time off for the care giver, fear of surgery, uncultured behavior of eye care personal, poor visual outcome, general govern- ments neglect of health care, lack of health insurance for vast majority of the population, healthcare funded by individuals as out of pocket despite grinding poverty, reliance on poorly coordinated and unsustainable outreach program, malpractices of quacks and traditional eye healers amongst other reasons. More than just a cataract: Cataract services require systematic evaluation of the patients’ general condition as well as the eye. Appropriate counseling is required to understand the goal and expectation of treatment. Adequate planning of surgery includes ocular biometry and provision of the appropriate intra ocular lens. The management protocol must ensure adequate measures are taken to prevent/ manage critical incidents whenever such a need arises. Conclusion: Cataract surgical services need to be patient centered with the goal of opti- mizing resources for quality outcome without compromising safety. and the underlying sclera is exposed. Limited bipolar wet field cautery may be applied to close bleeders. A horizontal incision of 6.5 to 7.0 milli meters is made 3 millimeters away from the limbus. A frown-shaped sclera incision pro-duces less astigmatism. The proximal sclera lip is gently lifted to allow using the crescent blade to construct a tunnel into the A/C. Thin tunnel roof can lead to button hole and a thick roof may lead to premature entry into the A/C. The tunnel is widened with a keratome as it enters the A/C. The internal opening should be 30% wider than the entrance wound. After administering viscoelastic material into the A/C, a lance is used to make a side port. Anterior capsulotomy is then performed. Nucleus is separated from the cor-tex by hydrodissection and maneuvered into the A/C by gentle rotation and subsequent delivery with vectis. In some instance, the surgeon may prefer to break the nucleus into halves using a pair of forceps before delivery. Viscoelastic material is used to cushion the endothelium and allow insertion, rotation, and dialing of the lens into position. The side port can be used toward this aim. With the IOL in position, any residual cortical matter and viscoelastic material are aspirated. Lens matter at the sclera tunnel entrance into the A/C is approached via the side port. Any residual viscoelastic material is aspirated. Antibiotic and steroid administration is similar to that of ECCE. MSICS was demonstrated to show