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Today's Practice | Apr 2009

5 Questions With Ghanta Madhavi, MD

Dr. Madhavi is the Medical Director of Goutami Eye Institute in Andhra Pradesh, India.

Describe the manual small-incision cataract surgery (SICS) technique you developed to prevent blindness.
Manual SICS uses a temporal scleral pocket incision with an approximately 2-mm entry into the clear cornea, which acts a as a valve to self seal the wound.  Conjunctival peritomy is made at the temporal limbus, with the 6-mm scleral groove performed 2 mm away from the limbus temporally.


I create a corneal valve for proper wound strength by tunneling 1.5 mm forward into the clear cornea. The 15° blade is placed through the 1.5-mm sideport incision, made 3 clock hours away from the main wound. An ophthalmic viscosurgical device (OVD) is injected. Then with an angled keratome we enter through the main wound, followed by creation of a 5-mm continuous curvilinear capsulorhexis. The tunnel is extended to its full length (6 mm) on either side. Hydrodissection is initiated to prolapse the nucleus into the anterior chamber, and OVD is injected in front of and behind the nucleus. The nucleus is removed either with the help of the OVD or an irrigating vectis. A thorough cortex wash is done, and a 6-mm three-piece IOL is inserted into the capsular bag. The OVD is aspirated and the anterior chamber reformed with balanced saline solution from the sideport incision. The wound is checked for firmness and integrity.


Postoperative treatment includes topical steroids and antibiotics for 4 days and then only topical steroids in a tapering dose for 6 weeks. Patients are examined on days 1 and 10 and after 6 weeks.


How does this procedure help eradicate blindness?
Because this technique takes only 3 minutes, requires minimal instrumentation, and is a low-cost alternative to phacoemulsification, ophthalmologists can treat hundreds of patients in 1 day. I see many patients with bilateral mature cataracts who are unable to afford and/or do not have access to treatment. We provide training to local ophthalmologists so that they can perform SICS. The more ophthalmologists we train, the more people will be saved from blindness. Local governments must take an active role to help people with cataract blindness—by reducing the price of surgery or by providing reimbursement—because affordability is a problem in some countries.


What other pearls can you offer surgeons that will help reduce the incidence of blindness worldwide?
There are many causes of blindness, such as cataracts, glaucoma, age-related macular degeneration (AMD), and refractive errors. People must be made aware of these conditions and take preventive measures by having an ophthalmologic exam after a certain age. Patient with one of the mentioned conditions must have regular check-ups.


It is imperative that a comprehensive ophthalmologist examine children's eyes for pediatric blindness, diagnosing conditions and referring young patients to a pediatric ophthalmologist if needed. Refractive errors in children can also be managed in this manner. Other problems, such as pediatric cataracts and glaucoma, should be managed meticulously. Also, it is important that a child's family be involved in the treatment plan. Doctors need to treat parents as part of the medical team.


Finally, the pharmaceutical industry must help limit blindness by reducing the prices of drugs for common eye diseases. If companies make drugs affordable for people in developing countries, ophthalmologists will be able to save more people from blindness.


What do you enjoy about mission trips?
First and foremost, I enjoy them because patients are happy after surgery. They have good vision, and that makes me elated. I also enjoy training local ophthalmologists. One time, the professors waited for me to come to their country for almost 1 year to perform cataract surgeries. I prefer to train the local ophthalmologists so that they can perform these operations.


On my last mission trip, I saw so many children with blindness due to untreated cataracts and glaucoma because this country did not have the proper equipment. We took the equipment from our last mission trip with us to train the local ophthalmologists.


Who is your role model?
I have several role models. First are my parents, who helped me become a doctor. They showed me that it is more important to help people than earn a lot of money. Next is my husband. During medical school, my parents arranged my marriage to Madhu, BVK, MSc, a community eye health postgraduate from London. Together, we took up the mission of helping people with blindness. We both take care of the day-to-day activities of Goutami Eye Institute. Finally, my mentor Dr. V.K. Raju, MD, FRCS, FACS, and chairman of our institute, changed my attitude toward ophthalmology as well as life. Since the 1970s, he has been working to prevent blindness. Dr. Raju has had a tremendous impact on my mission work.