SLIMCE results safe; skills transferable in rural setting

HONG KONG — Sutureless large-incision manual cataract surgery has been shown to be a practical, safe and transferable skill in both urban and rural settings, according to a speaker here.

Dennis SC Lam, MD, FRCOphth, described the technique and results it has produced in an experimental rural eye unit during Cataract and Refractive Surgery Subspecialty Day held prior to the World Ophthalmology Congress.

According to Prof. Lam, sutureless large-incision manual cataract surgery (SLIMCE) can play an important role in bringing safe and affordable surgery to more patients, particularly those in rural settings who would not otherwise be able to afford cataract surgery.

"I think SLIMCE procedures can be performed safely in rural settings, and skill transfer is possible with a very short learning curve even to inexperienced surgeons," Prof. Lam said.

Prof. Lam discussed prospective study results of 313 patients who underwent cataract extraction by two local surgeons in rural Sanrao, China. Of these, 85.2% had a preoperative visual acuity of 6/60 or worse. The postoperative uncorrected visual acuity was better than 6/18 in 86.3% of eyes, and the postoperative best corrected visual acuity was better than 6/18 in 97.1% of eyes, according to Prof. Lam.

The two surgeons who performed all the cataract extractions were trained to perform SLIMCE independently in 5 months. Since the Sanrao center was opened in December 2004, the same two surgeons have done more than 3,000 cataract surgeries using this technique, averaging around 100 cases per month, Prof. Lam said.

Of the Chinese population, more than 800 million people live in rural villages, he said. The ability to train rural surgeons to perform a technique that is safe and transferable is essential to providing much needed services to this underserved population.

"But before we do that in the village, we need procedures that are simple, safe, effective, easy to learn and easy to transfer the skills to local doctors," he said.

Prof. Lam and colleagues have also studied the endophthalmitis rate among those patients who have undergone SLIMCE in the rural hospital.

He said there have been three reported cases among 3,000 patients since December 2004. The low infection rate can be attributed to the fact that the procedure is done through the sclera and not clear cornea, and the wound is well-covered by the conjunctiva, according to Prof. Lam.

Overall, he said, the results from this experimental model "confirmed the effectiveness of skill transfer in rural areas with superior outcomes to most studies in rural Asia."