Cataract Surgery In A Tertiary Care Hospital: A Comparison Between The Pre-Covid-19 And Covid-19 Era

The COVID-19 pandemic led to cataract surgery being temporarily stood down on the recommendation of the The Royal College of Ophthalmologists, United Kingdom. On reinstating the service, longer cataract waiting times, more advanced cataracts and increased incidence of intra-operative complications were noted. This study measures and analyses the factors that may have contributed to the above and the measures taken which helped in alleviating the effect of the pandemic on the cataract surgery service in our trust.

Cataract surgery service at a Tertiary care hospital in the United Kingdom.

Retrospective study was performed. Data of all patients undergoing cataract surgery between May-October 2020 (during the early phase of the COVID-19 pandemic) was compared to May-October 2019 (pre-COVID-19). Finally, data of patients who underwent cataract surgery between May-October 2021 was analysed and compared with the previous 2 years. Intra-operative and post-operative complications, waiting times and cataract and surgeon grades were analysed and the mean pre-operative and post-operative visual acuity outcomes was compared.

651 eyes underwent cataract surgery from May-October 2020 compared to 1342 eyes in 2019. In 2020, 14.1% had brunescent cataract and 2.15% had posterior capsular rupture (PCR). In comparison, in 2019, 7.4% had brunescent cataract and PCR rate was 1.3%. Mean waiting time for those with PCR was 34 weeks in 2020 compared to 13 weeks in 2019. 92.7% patients had improvement in visual acuity post-surgery in 2019 and 86.4% in 2020. On reauditing, analysis of data of patients who underwent surgery between May-October 2021 showed more patients underwent surgery (1375), lesser rate of white cataract (9.2%), PCR reduction to 1.4% and decreased waiting time for those with PCR (19 weeks). 89% of patients noted improvement in visual acuity post-surgery.

Our study demonstrated higher proportion of dense cataracts with increased incidence of PCR during the peak of the COVID-19 pandemic in 2020. Patients who sustained PCR had waited longer for surgery. Steps to reduce wait times such as appropriate allocation of grade of surgeon to complexity of cataract, additional theatre sessions and dipping COVID-19 cases has helped in alleviating the pandemic impact to some extent in 2021. Even though waiting time has shown a reduction, it is yet to reach pre-pandemic levels.  This risks effect on quality of life of patients and higher complication rate. Some studies have found Immediate sequential bilateral cataract surgery to be safe and effective, which can help in further reducing waiting time.