Relevance
There are currently about 37 million blind people and 124 million visually impaired people worldwide. Of these, 47% are patients with cataracts [4]. Opacification of the lens of varying degrees occurs in 60–90% of people over the age of 60 [5].
Due to the general trend of the aging of the population, the number of patients with cataracts is steadily increasing. In this regard, the question arises of optimizing the approach to the organization of surgical treatment of cataracts. The introduction of early surgical treatment of the fellow eye (within one hospitalization), according to some authors [3], allows to reduce time and organizational problems, adding the benefits of early rehabilitation and quality of life of patients [1] without loss of quality of treatment.
Purpose of the study
To identify the average percentage of need at the time of discharge in the surgical treatment of cataracts in the fellow eye, to analyze surgical and postoperative complications during surgical treatment of both eyes in one hospitalization, including in the context of the conditions for providing medical care, to identify the preferential conditions for the provision of this medical service, the interval between operations.
Material and methods
In the course of the work, a retrospective analysis of discharge epicrises of 1388 case histories of patients who received surgical treatment for cataracts was carried out. The Orenburg branch of the FGAU IRTC "Eye Microsurgery" (Clinic) is a medical institution of the 3rd level, providing specialized, including high-tech medical care in a round-the-clock hospital, day hospital, outpatient.
In the course of the study, data were copied from the medical record of an inpatient (registration form No. 003/U) contained in the medical information system of the clinic. Uncorrected visual acuity of the fellow eye at discharge was analyzed. In the case of a diagnosis of cataract and uncorrected visual acuity of less than 0.5, this patient was recognized as in need of surgical treatment.
Patients with complete blindness of the fellow eye, as well as concomitant diagnoses affecting visual acuity (macular degeneration, advanced glaucoma) were excluded from the study. The total sum of the number of patients who need surgical treatment of both eyes within one hospitalization,
Based on the statistical data contained in the information system of the Department of Medical Control of the Clinic, an analysis was made of the number of patients who received cataract surgery on a paired eye for 2011–2015, an analysis was made of the existing gap between the surgical treatment of both eyes, an analysis of the preferential conditions was carried out provision of this service with justification of the reason.
Based on the data available in the information system of the Clinic, an analysis was made of the actual occurrence of surgical and postoperative complications in patients who received surgical treatment of cataracts within one hospitalization in the context of medical care.
For comparison (control group), we used the data obtained by us in the course of past studies on surgical and postoperative complications in all patients who received surgical treatment for cataracts in the clinic for 5 years (2011–2015, a total of 23855 eyes).
Evaluation of the prospects of this direction of organization of medical care for cataracts on the example of the Orenburg Branch of the Federal State Autonomous Institution "IRTC" Eye Microsurgery "n.a. acad. S.N. Fedorov.
Results and discussions
In total, at the stage of determining the need for surgical treatment of cataracts in the fellow eye, 1388 clinical cases of medical care were considered within one hospitalization.
61% were women, 39% were men, which generally repeats the general trend of age distribution of patients in the surgical treatment of cataracts in the Orenburg branch of the FSAU IRTC "Eye Microsurgery".
The visual acuity of the fellow eye at discharge ranged from 0.02 (2 eyes) to 1.0 (294 eyes). The distribution of visual acuity of the fellow eye at the end of treatment is presented in table.1.
Table 1
The distribution of visual acuity of the fellow eye during the surgical treatment of cataracts in the Orenburg branch of the FGAU IRTC "Eye Microsurgery" named after. acad. S.N. Fedorova.
Thus, the number of patients with a visual acuity of less than 0.5 at the end of hospitalization for treatment of cataracts in the fellow eye, therefore, in need of surgical treatment of the fellow eye, is 400.
The need for surgical treatment of the fellow eye in the treatment of cataracts is 28.81% (ratio 400 to 1388).
For 2011–2015 In the Orenburg branch of the FGAU IRTC "Eye Microsurgery" named after A.I. acad. S.N. Fedorov, surgical treatment on the fellow eye within one hospitalization was provided 1518 times, which is 6.36% of the total number of cataract operations (23855 eyes).
In the case of outpatient treatment, we determined a conditional period that defines the boundaries of one hospitalization, 10 days (in accordance with the standard for providing specialized medical care for cataracts, approved by the Ministry of Health of the Russian Federation) [6].
The interval between operations ranged from 1 to 7 days (Table 2), for the most part, the interval was 2 calendar days:
table 2
The interval between operations for cataracts on the fellow eye within the same hospitalization
In the treatment of both eyes within one hospitalization, 1355 eyes were operated on in a hospital (89%), 163 eyes (11%) were operated on an outpatient basis.
Outpatient medical care was provided for uncomplicated cases: initial senile cataract - 73 cases (44.79%), senile nuclear cataract (21.47%), inpatient care was provided for complicated cataract - 689 cases (50.85%), senile nuclear cataract cataract - 499 cases (36.83%).
The share distribution of diagnoses in the surgical treatment of the fellow eye during one hospitalization does not differ from the general distribution in cataract surgery (Table 2.1) [2].
The age of patients does not differ from the general distribution in cataract surgery (figure): the average is 67.8 years, the minimum is 25.4, and the maximum value is 94.97
Comparison of the age distribution of patients who received surgical treatment of both eyes in one hospitalization with the age of the patient of the general sample
Table 2.1
Proportional distribution of nosological units in the surgical treatment of the fellow eye per hospitalization in comparison with the overall distribution in cataract surgery
The distribution of surgical cases of medical care for the fellow eye within one hospitalization in the context of the conditions for providing medical care is presented in Table. 3.
Table 3
The number of operations on the fellow eye in the surgical treatment of cataracts within one hospitalization in the context of the conditions for providing medical care
Surgical treatment of the second eye in 99.54% was performed by phacoemulsification with IOL implantation (1511 eyes), intracapsular extraction was performed in 3 eyes (0.2%), extracapsular extraction in 4 eyes (0.26%), which also does not differ from method of surgical treatment in the general sample [2].
The share volume and characteristics of surgical complications in fellow eye surgery are similar to those in the general surgical treatment of cataracts.
Intraoperative damage to the iris occurred in 1 case (0.07% of cases versus 0.1% in general with cataract surgery), rupture of the lens capsule occurred in 7 cases (0.46% versus 0.55% in general with cataract surgery).
The proportion and characteristics of postoperative complications also do not differ from the general ones in cataract surgery: descemetitis was noted in 6 cases (0.4% vs. 1.49% in general in cataract surgery), corneal edema was recorded in 9 cases (0.59% vs. 0.91% in total).
Depending on the conditions of medical care, surgical complications were distributed as follows:
On an outpatient basis, all operations were completed without complications, and there were no postoperative complications in the outpatient surgical treatment of the fellow eye.
This is explained by the selection of uncomplicated cases for medical care in these conditions (Table 3).
conclusions
There is a significant need for surgical treatment of the fellow eye in the provision of specialized medical care for cataracts: the estimated share of operations on the fellow eye should be 28.81%, with the actual 6.36% in the Orenburg branch of the FGAUMNTK "Eye Microsurgery" named after. acad. S.N. Fedorov.
The possibility of surgical treatment of the fellow eye does not depend on the type of cataract, while the conditions for providing medical care are essential: surgical treatment of complicated cataracts can be performed on the fellow eye only in a hospital.
Under these conditions, the number and proportion of surgical and postoperative complications of surgical treatment of the fellow eye during one hospitalization does not differ, and sometimes even lower than in cataract surgery in general.
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