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 Table of Contents  
LETTER TO THE EDITOR
Year : 2021  |  Volume : 9  |  Issue : 2  |  Page : 91-92

Endophthalmitis: Has the surgeon genuinely not followed the protocols for cataract surgery - Need for contemplation before decision


Associate Professor, Department of Ophthalmology, Chandulal Chandrakar Memorial Medical College and Hospital, Bhilai, Chhattisgarh, India

Date of Submission09-Jun-2020
Date of Decision24-Feb-2021
Date of Acceptance03-Mar-2021
Date of Web Publication31-Jul-2021

Correspondence Address:
Lipi Chakrabarty
Department of Ophthalmology, C.C.M. Medical College, Durg- 490 024, Chhattisgarh
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/jcor.jcor_79_20

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How to cite this article:
Chakrabarty L. Endophthalmitis: Has the surgeon genuinely not followed the protocols for cataract surgery - Need for contemplation before decision. J Clin Ophthalmol Res 2021;9:91-2

How to cite this URL:
Chakrabarty L. Endophthalmitis: Has the surgeon genuinely not followed the protocols for cataract surgery - Need for contemplation before decision. J Clin Ophthalmol Res [serial online] 2021 [cited 2022 Jul 2];9:91-2. Available from: https://www.jcor.in/text.asp?2021/9/2/91/322796



Dear Editor,

Endophthalmitis following cataract surgery remains a nightmare for the involved surgeon and the hospital. The operating surgeon often gets pinned by the authorities or investigating committee for not following 'due protocols'. Protocols and checklists for cataract surgery are mandatory and should be recognized as guide to the management of the clinical situation or process of care that will apply to most patients. Multiple hospitals in India still do not have framed protocols for cataract surgery. In many cases, the investigating experts consider factors such as preoperative vision, blood pressure, and intake or instillation of certain medications strictly as per the state/national guidelines; irrespective of relation to the complication.

An English language database search was performed in January 2020 across PubMed, Embase, Cochrane Library database and Google search engine to identify suitable articles (from 1998 to December 2019) using certain relevant broad-scope index terms: cataract surgery, cataract extraction, protocols, guidelines- MeSH term and variations [Figure 1]. In addition, subtle related guidelines to prevent intraocular infection were manually retrieved from printed reports.
Figure 1: Brief of the Electronic database survey

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Multiple protocols are available in literature and practice with disparities [Table 1]. There are differences regarding- the visual criteria for case-selection, the acceptable level of systemic parameters, certain intraoperative procedures, and postoperative approach. According to the national cataract surgery manual developed in collaboration with VISION 2020, surgery is acceptable if the vision in the affected eye ≥6/18 while the Chhattisgarh health services guideline allows surgery if vision <6/60.[1],[2] National Institute for health and care excellence, UK states that cataract surgery is not to be limited based on visual acuity.[3],[4] Differentiation between acceptable pre-operative systemic parameters for patients with and without systemic ailments exists only in few protocols.[5]
Table 1: Comparison of few criteria of particular cataract surgery protocols

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Furthermore, current literature suggests liberal criteria for pre-operative blood pressure and glycemic levels. As per Kumar CM et al., patients with systolic blood pressure <180 mmHg, diastolic blood pressure <110 mmHg can proceed to elective cataract surgery and uncontrolled hypertension should not be the sole reason for the cancellation of cataract surgery.[6] As per another article, if the patient has hyperglycemia on the day of surgery, but has a good long term glycemic control (HbA1c that is age-appropriate, usually <8.5% or a pre-prandial blood glucose concentration of 108–180 mg/dl), it may be appropriate to proceed with the surgical procedure.[7]

Antibiotic prophylaxis (oral, topical, intracameral) needs addressal in view of recent evidences. There is a non-consensus on bilateral cataract surgery. Controversy on cataract surgery being 'admission' or 'day-care procedure'continues, especially with the government public health insurance schemes. Discordance on pre-operative screening for viral markers, pre-operative stoppage of anticoagulants, pediatric cataract surgery, etc., needs discussions. Non- translation of the protocols into legislative mandates is another grey zone.

In conclusion, the author suggests the investigation committee to bear in mind the non-uniformity among the guidelines; especially if the hospital where the surgeon is appointed has not framed its individual protocol. Minor deviations are to be respected if clinically justified. Periodic review of the protocols is warranted. Local practice conditions should be considered when national guidelines are followed in any institution.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
  References Top

1.
Guidelines for the Management of Cataract in India. VISION 2020: The Right to Sight INDIA Publication; October 2011. Available from: https://www.sightsaversindia.in/wp-content/uploads/2019/03/16480_Cataract_Manual_VISION2020.pdf. [Last accessed on 2020 Jan 05].  Back to cited text no. 1
    
2.
Directorate of Health Services, Chhattisgarh. Protocol for Cataract Surgery. Feb 2013. Available from: https://csos.in/uploads/downloads/1489391858atract%20Surgery%20SOP%20NPCB.pdf. [Last accessed on 2020 Jan 05].  Back to cited text no. 2
    
3.
National Institute for Health and Care Excellence. Cataract Surgery Guidelines; 2017. Available from: https://www.nice.org.uk/guidance/ng77. [Last accessed on 2020 Jan 05].  Back to cited text no. 3
    
4.
5.
Aravind Eye Care System. Standardized Cataract Surgery Protocol. Available from: http://v2020eresource.org/content/files/Cataract%20Surgery%20Protocols.pdf. [Last accessed on 2020 Jan05].  Back to cited text no. 5
    
6.
Kumar CM, Seet E, Eke T, Joshi GP. Hypertension and cataract surgery under loco-regional anaesthesia: Not to be ignored? Br J Anaesth 2017;119:855-9.  Back to cited text no. 6
    
7.
Kumar CM, Seet E, Eke T, Dhatariya K, Joshi GP. Glycaemic control during cataract surgery under loco-regional anaesthesia: A growing problem and we are none the wiser. Br J Anaesth 2016;117:687-91.  Back to cited text no. 7
    


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