SEEING PROGRESS
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Cataract surgery in action
Dr. Barr with his host family in Banakrishnapur.
Dr. Barr in the Operating Room.
Expeditions (SEE) International, an organization based in California with
outreach programs around the globe. I first flew to Calcutta to meet with
Dr. Bikas Battacharya who has taught many American ophthalmologists
techniques of cataract surgery. Calcutta is a teaming city with a population
of 10 million and is an experience in itself. After a day of instruction, Dr.
Bhattacharya and I traveled to an eye hospital in Banakrishnapur, which is
about 40 miles (three hours) west of Calcutta. There, screeners had arranged
for 30 patients to undergo cataract surgery. I was very graciously hosted by a
local family, and it was interesting to learn that this was one of the few houses
in the village that had running water.
The patients traveled to the eye hospital from outlying villages, and spent
the night before surgery in the hospital. Preoperative rounds were made at
the bedside with a flashlight. The next day, the patients came to the oper-
ating room for their cataract surgery. Patients were shuttled back and forth
between two operating tables with the operating microscope and the surgeon
in between. The surgeon operated first on the right-hand table and then the
left, which I have learned is a standard in many third-world countries. Local
anesthesia with Xylocaine was expertly administered by the local nurses and
surgical technicians. One bag of lactated ringer solution was used throughout
the day to provide irrigation for the patients undergoing cataract surgery.
In the developed world, cataract surgery is performed with an ultrasonic
probe and is called phacoemulsification. In the third-world, cataract surgery
is simpler and differs somewhat from the standard phacoemulsification
procedure. A relatively large self-sealing incision is made, and the nucleus
of the cataractous lens is then extracted. The residual cataract is aspirated
manually with a hand-held syringe, and an artificial lens is implanted. It is of
interest that sutures are rarely necessary, and only provided in special cases.
Antibiotics are injected at the conclusion of the case, and topical antibiotics are
provided to each patient. In spite of the relatively unhygienic conditions when
compared to operating rooms in the United States, infection rates are low.
On the first postoperative day, rounds were made with a handheld flash-
light. I was somewhat shocked and pleasantly surprised that of the 15 patients
that I had operated on the previous day, 11 patients had clear corneas, deep
anterior chambers and round pupils - in short, an excellent first postopera-
tive day result. The other four patients had mild corneal edema, but all did
quite well.
In the operating room with two patients.
Post-operation pateitns, one day after surgery.
My experience with SEE International and third-world ophthalmology
has been inspirational. I am looking forward to continued work with this
organization in an attempt to help those less fortunate than those of us in
the United States.
Dr. Barr is the Arthur and Virginia Keeney Chair of Resident Education and Ethics in Ophthalmology
at the University of Louisville School of Medicine.
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