Care after cataract surgery in Nairobi, Kenya

explained. Patients are also advised to see an ophthalmologist immediately if they have sudden pain, redness or decreased vision. At Aravind, great importance is given to counselling: speciallytrained counsellors are given the job of adequately advising patients and answering any questions they may have. At the end of counselling, a checklist is used to ensure all relevant aspects are communicated to the patient (Figure 1). Patients are also told when they can resume various activities. Most patients who were admitted are discharged on the fi rst postoperative day; however those coming as a result of our outreach activities are discharged on the second or third day depending on the distance to their village. A detailed discharge summary is given which includes the details of the postoperative medications, i.e. topical steroid and antibiotic eye drops. Steroids are used 6 times per day for the fi rst week and tapered each week over 6 weeks. Topical antibiotics are used 3 times daily for 2 weeks postoperatively. Topical non-steroidal anti-infl ammatory drugs (NSAIDs), such as nepafenac or ketorolac, are generally started routinely at the 1 month follow-up visit to reduce the incidence of cystoid macular oedema (CME) and to prevent rebound infl ammation, which may occur after the steroids are tapered and stopped. In high risk cases such as PCR with vitreous loss, or if there was CME following surgery to the fi rst eye, NSAID drops are started immediately after surgery. At the fi rst month follow-up visit, patients undergo refraction and spectacles are prescribed based on their needs. Their intraocular pressure is checked to rule out raised intraocular pressure following the use of topical steroids. The eye is examined comprehensively for any sequelae following surgery and the other eye is assessed in order to plan the timing of a cataract operation on the second eye, if needed. Some patients may be called back sooner than one month if there were any surgical or postoperative complications. Patients are advised to undergo an annual follow-up examination after surgery in both eyes. Whereas the surgeon and eye team have a greater role to play in the surgical care, postoperative care involves sharing responsibility between the eye team and the patient. It is crucial that the patient is educated regarding the importance of compliance with treatment and follow-up in order to ensure an excellent outcome.