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Comparison of cataract surgery outcomes between a secondary and a tertiary eye hospital in Tamil Nadu, India



To examine the difference in post-operative visual outcomes of cataract surgeries between a tertiary and secondary centre at Aravind Eye Hospitals in Tamil Nadu, India.


Our retrospective cross-sectional study analysed cataract surgeries at a secondary centre and its associated tertiary centre in 2021. Our main outcome measures were postoperative best corrected visual acuity (BCVA), spherical equivalent, and intraoperative and postoperative complications. Two-sample proportion tests and logistic regression analyses were performed.


The analysis of 32,302 cataract surgeries in 2021 of which 4357 were performed at the secondary centre and 27,945 were performed at the tertiary centre showed that the tertiary centre operated on more advanced cataract condition (p < 0.001). Intraoperative (p < 0.001) and post-operative complication rates (p < 0.001) were higher in the tertiary centre. The odds of effective outcomes (BCVA > = 6/12) controlling for all covariates are poorer (p < 0.0001) in the tertiary centre for both phacoemulsification (phaco) and manual small incision cataract surgeries (MSICS).


World Health Organization recommendations for the effective outcome of cataract surgery are met by both the tertiary and secondary centres, but the odds of effective outcomes in the tertiary centre was lower after adjusting for all known factors. Further investigations of the causes of poor vision in both phaco and MSICS in the tertiary centre are needed to improve the situation.

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Fig. 1: Locations of patients who received cataract surgery at Aravind Eye Hospitals in Tirunelveli (tertiary hospital) and Tuticorin (secondary hospital) in 2021.

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Data availability

The datasets generated during and/or analysed during the current study are available from the corresponding author on reasonable request.


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Authors and Affiliations



G-BSB was responsible for literature review, conceiving and designing the study, data acquisition, data analysis, interpretation, writing and reviewing the manuscript. AG and SC were responsible for conceiving the study, data acquisition and review the manuscript. TR and FvM were responsible for designing the study, data analysis, interpretation, and reviewing the manuscript. SG was responsible for data analysis, literature review and manuscript review. RDR was responsible for interpretation and review of manuscript. LB analysed the data and reviewed the manuscript.

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Correspondence to Ganesh-Babu Balu Subburaman.

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Subburaman, GB.B., Gunasekaran, A., Chandrashekaran, S. et al. Comparison of cataract surgery outcomes between a secondary and a tertiary eye hospital in Tamil Nadu, India. Eye 38, 335–342 (2024).

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