Quality of cataract surgery in a high volume setting at Lions Sight first Eye Hospital, Kenya

Objective: To investigate whether routine high volume cataract surgery can be performed without compromising quality of surgery. Design: Retrospective study Setting: Loresho Lions Eye Hospital Nairobi, a high volume eyecare center Subjects: 368 patients operated by two surgeons Results: Within 5 randomly selected theatre days (5 operating hours per day); the two  surgeons had performed a total of 368 cataract surgeries. The average time per surgery was 4.25 minutes. The mean age of the patients was 67.13 (SD +_10.11). 201 (54.6%) were females and 167(45.4%) were males. 301(81.8%) patients achieved post operative uncorrected visual acuity (UCVA) of 6/18 and better by the 4th week while, 58(15.7%) achieved UCVA between 6/24-6/60 and 9(5.2%) patients had UCVA of less than 6/60. 315(85.6%) patients had a preoperative uncorrected visual acuity between PL and 5/60, 52 patients(14.2%) between 6/60-6/24 and 1(0.3%) patient had preoperative visual acuity of 6/18. 6(1.6%) patients had intraoperative complications: 1(0.3%) patient had a posterior capsule tear without vitreous loss, 2(0.5%), posterior capsule tear with vitreous loss and 3(0.8%) had iris bleeding. Postoperative examination done at the camp site (day 30) did not reveal any anterior segment complications in all the 368 patients. One aphakic patient was not improving with +10 and was found to have cystoid macular edema.15 patientswere found to have PCO and had UCVA between 6/24-6/60. Forty three eyes (12.9%) had immediate (day 1) post operative complications. 10(3.0%) cases had transient corneal oedema with 10 descements membrane folds, 16 (4.3%) transient corneal edema, 1 (0.3%) shallow anterior chamber, 2 (0.5%) mild iritis and 2(0.5%) peaked pupil. All the immediate complications were (according to Oxford Cataract Treatment Evaluation Team (OCTET) grading trivial and were not likely to result in a marked drop in visual acuity. Preexisting ocular pathology was the most importact cause of poor post operative outcome: Optic atrophy (4 patients), Age Related Macular Degeneration (3 patients), Macular hole (1 patient), Macular scar (2 patients) and Glaucoma (1 patient). Conclusion: The study results show that high quality cataract surgery can be attained in a high volume setting.