Bulgarian ophthalmologist welcomes joining ECOSG

By Ana Hidalgo-Simon

Amsterdam - As part of EuroTimes' on-going reporting of the experiences of different countries within the European Cataract Outcome Study Group, we look at Bulgaria.
Vesselin Daskalov MD, from the Eye Clinic of University Hospital 'Alexandrovska' in Sofia, discusses his participation in the study.

Bulgaria has five University clinics for ophthalmology and about 20 ophthalmology departments where ophthalmic surgery is performed. Cataract operations constitute the bulk of the surgical activity buy there are also some recently published private clinics in operation.

Up until the late '70s, cataract surgery in Bulgaria consisted of cryoextraction without subsequent IOL implantation. The first implant was performed by Professor Konstantinow in 1979 using his self-designed iris clip lens. That year also saw the first phacoemulsification in Bulgaria.

Going it alone in the early days
National production was initiated to solve the problem of importing lenses. Three types of lenses were produced; the most popular model was the posterior chamber iris fixed called Ubileina (Jubilee) invented in 1979. The practice grew relatively slowly, with only 45 IOLs implanted in the period 1979-1983 at the Eye Clinic of UH Alexandrovska University Clinic of Sofia, then considered (and still regarded as) the leading edge of innovation in ophthalmic surgery in the country.

From 1984, extracapsular extraction became the preferred method for cataract surgery. A new phase commenced in 1989 with the diversification of surgical procedures and a sharp rise in the types of IOL available.

Dr Daskalov noted that the last decade has seen a remarkable increase in the number of cataract removals followed by IOL implantation.

In the University Eye Clinic in Sofia, lens implants were performed in 24% of cataract
operations in 1991. This had increased to 93.5% by the year 2000. The rest of the country followed the same trend although in a less enthusiastic way; a rate of less than 20% of implants in the early '90s increased to around 76% in 2000.

Phacoemulsification also took a leap forward with the introduction of modern phaco equipment in 1995. Around 15% of cataract operations in Bulgaria are now performed using phaco, with foldable lenses still only used in 10% of patients.

Results for the ECOSG
Dr Daskalov operated on the 32 patients included in the European Cataract Outcome Study for the period 2000/01. The average age of his patients was 67, six years younger than the study mean.

The results presented at the ESCRS Amsterdam meeting and reported here relate only to the Department of Ophthalmology at the University Hospital Alexandrovska Clinic in Sofia.

All patients received local retro- or peribulbar anaesthesia. The percentages of concomitant eye diseases were close to the European average for glaucoma (12.5%) and diabetic retinopathy (6.25%), but well below that for other diseases such as macular degeneration (6.25% in his group and 36.66% the European mean).

Only 31% of Dr Daskalov's patients were operated using phacoemulsification. Around 62% had extracapsular cataract extraction followed by posterior chamber lens implantation. The European average for this procedure was 6.5%.

The majority of patients operated in Sofia received a PMMA lens (81%) and the remainder acrylic IOLs. The most popular lenses implanted in Bulgaria are currently Alcon (Crystal series) and Chauvin (Opsia). No complications were reported during the study month.

Postoperative astigmatism was 1.25 D (1.1 D is the European average), while postoperative uncorrected visual acuity was 91% (for VA 0.5), 78% (VA 90.8) and 59% (VA 1.0). Best-corrected VA was 94%, 81% and 59% (for VA 0.5, 0.8 and 1.0 respectively).

"I welcome wholeheartedly the ECOSG initiative. <The possibilities for information exchange are great, and the anonymity of the process guarantees its authenticity. > The possibility of comparing myself to the rest of the participants is the real benefit for me in participating. I intend to use this information for training purposes in my centre," Dr Daskalov remarked.

The ECOSG initiative will improve the collaboration of centres between western and eastern Europe. It is a step forward in the direction of European integration and the establishment of a common European home, he added.

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