Clinical prole and visual outcome of complicated cataracts in eye care center in western central India

Introduction: Complicated cataract having poor prognosis, because of comorbidities. We tried to study visual outcomes in all clinical conditions. Methods: This is prospective cohort study to develop scoring system to predict visual outcome in case of complicated cataracts. We enrolled all complicated cataracts fullling inclusion criteria between august 2019 to 2020.For All enrolled cases data collected in pre tested online format in Electronic medical records. All data exported and analysed with SPSS 22 using descriptive, cross tabulation and One sample T test functions. Results: Our cohort was consisted of 230 eyes of 230 patients with mean age 44+/-21.22 years with 121/230(52.6%) female and 109/230(47.4%) male. Traumatic cataracts (64/230) Cataract with Corneal opacity (45/230) Post uveitic cataract (43/230) Neglected cataract (39/230).We had 37/230 (16.1%) pediatric population with signicant poor outcome. We found signicant difference in pre and post-operative visual outcome. Conclusion: Complicated cataracts with different co morbidities has signicant improvement in visual outcome following comprehensive management. Neglected cataracts has better outcome than other categories.


Introduction
Cataract blindness Cataracts are responsible for 47% of all cases of blindness worldwide. The epidemiological impacts of cataracts are not the same in different countries, and the rates are associated with the prevailing economic conditions. In developed countries with good healthcare, cataracts account for only 5% of the cases of blindness, whereas the issue is still responsible for 50% of such cases in the developing countries. After a brief overview of the historical, clinical, and therapeutic aspects, this article presents an update on the global epidemiological cataract data. It also provides insights into the political, socioeconomic, and cultural factors that adversely affect the availability of healthcare in developing countries, making cataract a major public health concern and an impediment to development. [1] The prevalence of cataracts increases with age. As the world's population ages, the incidence of cataractinduced visual dysfunction and blindness is rising, which represents a signi cant global problem. The challenges include preventing or delaying the formation of cataracts and treating those that occur. [1] Cataracts can be cured by surgery, however, this option is not equally available everywhere and all surgical methods do not produce similar outcomes. Standard surgical services capable of providing good visual rehabilitation must be made accessible to all in need, regardless of their circumstances. The establishment and sustained delivery of these services requires comprehensive strategies that go beyond a narrow focus on surgical techniques. Changes in governmental priorities, population education, and an integrated approach to surgical and management training are warranted. [2] India is a signatory to the World Health Organization Resolution on Vision 2020. The concerted efforts of all the stakeholders have resulted in a hike in the number of cataract surgeries performed in the country. However, the actual impact of these measures on the elimination of avoidable blindness is unknown. [3] Visual outcome of cataract various risk factors impact the outcome of cataract surgery. Each of these risk factors increases the possibility of an adverse outcome during cataract surgery. However, until recently, prediction of the likelihood of a complication during phacoemulsi cation surgery has been based on a subjective assessment of the patient by the surgeon. Various studies have identi ed individual risk factors that increase the risk of intraoperative complications. [1][2][3][4][5] There are complicated cataracts secondary to or coexisting with other ocular conditions may not have similar outcome as uncomplicated primary cataracts. All patients were followed up according to standard format and schedule.
All pre operative scores divided in 3 categories 1-5 ,6-10 and > 10 which was studied comparing visual outcome. Prognosis was worsen from small to large.
All data were included in pre tested online format in EMR data exported in excel sheet and analysed using SPSS 22 with descriptive and cross tabulation function. All numerical variables tested by One sample T test.

Discussion
Over the last 2-3 decades, it has been proven that cataract surgery has been of immense bene t in visual rehabilitation of patients with uveitis and cataract. Cataract surgery with lens implantation has been established as a safe modality of treating cataract in pts with uveitis. (9,10) Conventional cataract surgery for complicated cataract secondary to chronic uveitis is confronted with many complications, such as recurrent in ammation, pupillary membrane, glaucoma, etc. [11] This could be due to existing cystoid macular oedema as a part of the uveitic disease process, as has been reported by Diamond et al [12]. But it is hard to determine pre-existing ndings before We are not aware about any study reported similar ndings for all clinical conditions.

Conclusion
Complicated cataract with coexisting morbidities has signi cant improvement in vision after cataract surgeries with different techniques. Neglected cataracts has better visual outcome than other clinical conditions.