A comparative study of endothelial cell loss in small incision cataract surgery versus phacoemulsification cataract surgery by using specular microscope at tertiary care ophthalmic centre in Bengaluru, Karnataka

Abstract

Most commonly performed surgical procedure in Ophthalmology is cataract extraction by MSICS and Phacoemulsification. It has always been associated with damage to endothelium of cornea, a layer which is vital for maintaining corneal transparency. The corneal endothelium regulates stromal hydration and maintains the transparency of the cornea by constantly removing the fluid out of the corneal stroma. The density of corneal endothelial cells and its integrity is an important determinant for corneal transparency. Post-operative corneal decompensation leading to reduced visual acuity can occur as a result of this surgical trauma. Hence it is necessary to determine the surgical technique safest to corneal endothelium. Specular microscopy helps to determine this corneal endothelial cell density. A hospital based longitudinal study was done from November 2017 to May 2019 in 124 patients at Minto Ophthalmic Hospital. 62 patients underwent MSICS and 62 phacoemulsification. After a written informed consent patients were evaluated with detailed history, slit lamp examination, direct and indirect ophthalmoscopy, biometry, lacrimal syringing, IOP measurement with tonometry and endothelial cell count was evaluated using non contact specular microscopy preoperatively and postoperative 1 week and 6 weeks. Statistical data analysed by unpaired – t test. The mean ECC (cells/mm) in MSICS and phacoemulsification group preoperatively was 2486.82 + 152.730 and 2433.71 + 192.692 respectively. The mean endothelial cell loss (cells/mm) was 314.61 + 64.428 and 324.31 + 30.67 at 1 week and 345.71 + 66.68 and 354.95 + 53.885 at 6 weeks postoperatively between the two groups. The endothelial cell loss was not statistically significant at 1 week (p -0.28) and 6 weeks (p-0.39) postoperatively between the two groups. There was no clinically or statistically significant difference in the endothelial cell loss between MSICS and Phacoemulsification. As MSICS is economical and less dependent on technology, it can be a safe option in developing world.