Incision Cataract Surgery Research Articles

Corneal Biomechanics and Other Factors Associated with Postoperative Astigmatism after Cataract Surgery.

This study aimed to investigate the impact of the cornea's biomechanical properties, corneal hysteresis (CH), and corneal resistance factor (CRF) on postoperative astigmatism after cataract surgery and determine the other factors that influence it. Forty eyes of 40 patients (13M/27F; the median age of 74) were included in this prospective study, underwent 2.75 mm incision cataract surgery, and were followed for 30 days. Visits were scheduled at baseline before surgery (V0), the 1st (V1), the 7th (V2), and the 30th (V3) postoperative days. The main parameters estimated and analyzed with Statistica® 14.0.1 were CH, CRF, astigmatism diopter, and axis. Following the cataract surgery, the CH did not significantly change during the study visits (p = 0.109). However, there was a significant change in the CRF from baseline during the study visits (per protocol set) (p = 0.002). After a slight but insignificant increase from V0 to V1, post hoc analysis found a significant decrease in the mean CRF from V1 to V2 (p = 0.049) with no substantial change from V2 to V3. According to the post hoc analysis, the median astigmatism diopter increased significantly only from V0 to V1 (p = 0.001) and slightly but not significantly decreased to the end of the study with the achievement of a near-baseline value. The main predictors for the final astigmatism diopter (R2 = 0.898) obtained by stepwise regression analysis were its values at V0, V1, and V2 (p < 0.001). The CRF at V1 was marginally significant, with a negative parameter estimate of -0.098303 (p = 0.0623). In conclusion, there was no correlation between preoperative CH and CRF and postoperative astigmatism using 2.75 mm incision cataract surgery. However, the final astigmatism diopter's main predictors were its baseline values before cataract surgery, the first, and the seventh postoperative days.

Evaluating the safety and operability of asymmetric trapezoid and near-square side-port incision in cataract surgery.

To compare the accuracy, safety, and consistency of asymmetric trapezoid and near-square side-port incision in cataract surgery. Aier Eye Hospital of Wuhan University, Wuhan, Hubei Province, China. Prospective pilot study. This study included patients who underwent phacoemulsification between January 2022 and August 2022. They were divided into Group A and Group B using the random number table method. Group A was given a near-square side-port incision and Group B was given an asymmetric trapezoid side-port incision. We contrasted the differences in incision length, width, and shape; surgical time; and postoperative intraocular pressure (IOP) between the 2 groups. 220 eyes of 220 patients were included. The mean external width of the incision in Group A was much smaller than that in Group B ( P < .01), and the consistency of the incision diameter in Group A was better than that in Group B. There was no statistically significant difference in incision length between the 2 groups ( P = .75). 1 day after surgery, there was no statistically significant difference in incision morphology between the 2 groups ( P = .72). The operating time for Group A was significantly shorter than that of Group B ( P < .01). There was no obvious incision leakage in both groups after surgery, and the IOP was generally elevated after surgery, but there was no significant statistical difference between the 2 groups ( P = .98). The present study suggests that a near-square side-port results in better consistency of incision width and shorter surgical time.

Intraocular Lens Materials: A Detailed Assessment of Benefits and Drawbacks

Intraocular lenses (IOLs), which are used to repair vision in a large number of patients following cataract surgeries, are potentially the most significant single advancement in ophthalmology. The first IOLs were made by the only biomaterial available for implantation over decay which is a rigid plastic namely, polymethyl methacrylate (PMMA), The main drawback of PMMA is that it necessitates the largest incision in cataract surgery, with the corneal incision is as large as the optics of the IOLs. Because the essential intention of forward-thinking cataract surgery is to make the smallest incision possible, the IOLs must be adaptable and bend. This intention can be accomplished by enhancing the model and matter of IOLs. There are also some characteristics associated with IOLs materials that may have some impact such as (Refractive Index, Water content, Glistening, Etc.), The improvement of the first silicone IOLs used to overcome that problem but it is now rarely used and has been replaced with an Acrylic hydrogel material that provides a good performance; researchers are still evaluating suitable IOLs materials.

Predictability of Astigmatism Correction by Arcuate Incisions with a Femtosecond Laser Using the Gaussian Approximation Calculation.

Planning astigmatic correction is a complex task. Biomechanical simulation models are useful for predicting the effects of the physical procedure on the cornea. Algorithms based on these models allow preoperative planning and simulate the outcome of patient-specific treatment. The objective of this study was to develop a customised optimisation algorithm and determine the predictability of astigmatism correction by femtosecond laser arcuate incisions. In this study, biomechanical models and Gaussian approximation curve calculations were used for surgical planning. Thirty-four eyes with mild astigmatism were included, and corneal topographies were evaluated before and after femtosecond laser-assisted cataract surgery with arcuate incisions. The follow-up time was up to 6 weeks. Retrospective data showed a significant reduction in postoperative astigmatism. A total of 79.4% showed a postoperative astigmatic value less than 1 D. Clinical refraction was significantly reduced from -1.39 ± 0.79 D preoperatively to -0.86 ± 0.67 D postoperatively (p 0.02). A positive reduction in topographic astigmatism was also observed (p < 0.00). The best-corrected visual acuity increased postoperatively (p < 0.001). We can conclude that customised simulations based on corneal biomechanics are a valuable tool for correcting mild astigmatism with corneal incisions in cataract surgery to improve postoperative visual outcomes.

Experimental analysis of recommended corneal incision sizes in cataract surgery using 13 intraocular lens injector systems

Smaller corneal incisions in cataract surgery are linked with a better visual outcome and less frequent postoperative endophthalmitis. The insertion of intraocular lens (IOL) injector systems into the anterior chamber of the eye to implant an IOL is associated with incision enlargement (IE) impeding these positive effects. The aim of this study was to compare manufacturers’ recommended incision sizes (IS) of 13 different intraocular lens injector systems in regard of intraoperative IE and postoperative IS. In total, 499 corneal incisions in ex vivo porcine eyes were analyzed. The preoperative ISs depended on the recommended IS of the examined injector system. The IS was measured right before and after IOL injector insertion with an incision gauge set. There was intraoperative IE in 87% of the incisions with a mean IE of 0.26 ± 0.18 mm. IE was often significantly larger in small IS compared to larger IS concerning an injector system (P < 0.05). Five injector systems needed to have a significantly larger IS than the manufacturers’ recommended IS with an average difference of 0.3 mm when applying study criteria (P < 0.05). Thus, the present study shows that IS recommendations require to be critically analyzed by ophthalmic surgeons to enable evidence-based practice.

Functional Profile of a Customized Wound Parameter in Femtosecond Laser-Assisted Corneal Incision for Cataract Surgery.

To evaluate the performance of optimized parameters of femtosecond laser for cataract surgery corneal incisions regarding opening, patency and surgically induced astigmatism (SIA). Patients scheduled for femtosecond laser-assisted cataract surgery between May 2018 and December 2018 were enrolled. Inclusion criteria were a healthy preoperative cornea and uneventful FLACS. Exclusion criteria were preoperative corneal astigmatism over 1.0 D, previous corneal trauma or pathologies. Clinical data were obtained from the electronic medical records. Surgical planning was based on Scheimpflug tomography images for keratometric data. At postoperative day 60, new keratometric evaluation was performed, obtained using the same device. 101 eyes (61 patients) matched the criteria for SIA analysis. Overall mean SIA was 0.44 ± 0.33 D (0-1.55 D). Axis and size did not have any statistically significant effects on SIA. The overall centroid of the SIA was 0.11. For the opening analysis, was included 156 eyes (79 patients). Successful opening in 87.7% of cases (137 eyes). Temporal incisions had the highest success rate (98.36%). These femtosecond laser parameters showed high opening rates with low opening times. These optimized parameters led to a low incidence of SIA and high predictability regardless of incision site and size. The association between incision opening and SIA was not statistically significant. There was, however, an association between incision opening success and site.

The Impact of Posterior Corneal Astigmatism on Surgically Induced Astigmatism in Cataract Surgery.

This study aimed to evaluate the changes in posterior corneal astigmatism after cataract surgery and provide a theoretical basis to accurately evaluate the total corneal astigmatism (TA) to be corrected before toric intraocular lens (IOL) implantation. Sixty-two patients (89 eyes) who underwent phacoemulsification combined with toric IOL implantation (AcrySof IQ Toric SN6AT2-T9) at Shanxi Eye Hospital between January 2017 and September 2018 were enrolled. Surgically induced astigmatism of the posterior cornea (SIAPA) was analysed using vector analysis during pentacam examination. The vector variances of keratometric astigmatism (KA), TA, and posterior corneal astigmatism (PA) preoperatively and postoperatively in the "with-the-rule (WTR) astigmatism" group and "overall patient" group were statistically significant (P < 0.05). A statistically significant difference was observed between surgically induced KA (SIAKA) and surgically induced astigmatism of the total cornea (SIATA) for all patients, including those with WTR astigmatism. For all patients, SIAKA was less than SIATA by 0.05 ± 0.21 D, and for patients with WTR astigmatism, SIAKA was less than SIATA by 0.09 ± 0.22 D. For patients in the "against-the-rule (ATR) astigmatism" group, there were no statistically significant differences between SIAKA and SIATA, although SIAKA was greater than SIATA by 0.03 ± 0.18 D. When PA ≤0.4 D or KA ≤2.0 D, SIAPA can be ignored. However, when PA >0.4 D or KA >2.0 D, ignoring SIAPA caused by cataract surgery incision will cause SIAKA in patients with WTR astigmatism to underestimate SIATA, while SIAKA in patients with ATR astigmatism will cause an overestimation of SIATA. SIA on the posterior corneal astigmatism may have a significant role on more precise planning of toric IOL implantation, especially in cases with higher preoperative anterior or posterior corneal astigmatism.

Commentary: Surgically induced astigmatism in manual small-incision cataract surgery incision types: Is the correlation linear?

Commentary: Surgically induced astigmatism in manual small-incision cataract surgery incision types: Is the correlation linear?

Comparison of Three-Dimensional Surgical System Versus Binocular Microscope for Clear Corneal Incision in Cataract Surgery.

IntroductionTo compare surgical outcomes of 2.2 mm clear corneal incision (CCI) between a three-dimensional (3D) visualization system and traditional binocular microscope (BM) for phacoemulsification and intraocular lens implantation surgery.MethodsIn this randomized controlled clinical study, 60 eyes with age-related cataracts were divided into two groups receiving cataract surgery using either a 3D vision system (n = 30 eyes) (3D group) or a binocular microscope (n = 30 eyes) (BM group). We recorded and statistically analyzed surgical parameters and pre- and postoperative ocular parameters. Primary outcomes included the change in endothelial cell density (ECD) and CCI architecture, and secondary outcomes comprised other ocular parameters and surgical parameters. All procedures complied with the tenets of the Declaration of Helsinki.ResultsOf the 60 eyes randomly assigned between January 5, 2021, and May 9, 2021, 55 (26 eyes in the 3D group and 29 eyes in the BM group) were analyzed. The ECD loss rate was 8.1% in the 3D group and 12.3% in the BM group, but the difference was not statistically significant. Local detachment of Descemet’s membrane was seen in 50% (13 eyes, 3D group) and 51.6% (15 eyes, BM group), wound gaping at the endothelial side in 15.4% (four eyes, 3D group) and 10.3% (four eyes, BM group), gaping at the epithelial side in 11.5% (three eyes, 3D group) and 6.9% (two eyes, BM group), and misalignment of the incision in 3.4% (one eye, BM group) 1 day after surgery. These abnormalities improved with time. There was no difference between the 3D group and BM group in terms of other ocular parameters or surgical parameters before and after surgery.ConclusionsUsing the 3D surgical system for phacoemulsification and IOL implantation surgery seems to result in similar ECD and CCI conditions as using a conventional binocular microscope.Trial RegistrationThe protocol was registered on ClinicalTrials.gov (NCT04839250).

Estimations of Critical Clear Corneal Incisions Required for Lens Insertion in Cataract Surgery: A Mathematical Aspect

In a routine cataract operation cornea tissue may be damaged when an intra-ocular lens (IOL) injector of diameter between 1.467 and 2.011 mm is inserted through an empirically designed 2.2 mm corneal incision. We aimed to model and estimate the minimal length of the incision required to avoid wound tear. It was assumed that the damage was caused by tissue fracture at the tips of the incision, and this fracture could be studied using damage and fracture mechanics. The criterion of the damage was caused by a tear governed by the critical energy release rate (ERR) G c , which is tissue dependent. Analytical and numerical studies were both conducted indicating the possibility of a safe and effective incision in cataract surgery. Six commonly used IOL injection systems were examined. Our results suggested that the recommended 2.2 mm incision cannot be treated as a universal threshold. Quicker IOL insertion may reduce wound damage. It was also recommended to advance IOL injector via its minor axis, and to cut the tear preferably along the circumferential direction due to tissue orthotropy. This study provides useful information and a deeper insight into the potential for mechanical damage to the corneal wound in cataract surgery.

Effect of corneal incision features on anterior and posterior corneal astigmatism and higher-order aberrations after cataract surgery.

To evaluate the influence of 2.2mm clear corneal incision (CCI) features in surgically induced astigmatism (SIA) and higher-order aberrations (HOAs) after cataract surgery. Right eyes of 92 subjects receiving 2.2mm incision cataract surgery were involved. A total of 38 eyes were categorized as the intact incision group, and 54 eyes were the defective incision group. Pre- and postoperative (1month and 6months) corneal astigmatism and HOAs on anterior and posterior corneal surfaces, corneal volume, and corneal thickness (CT) were measured using Pentacam. The CCI features including incision length (IL), incision angles, distance from incision to central cornea (Dis-En/Ex), and CT at incision site were quantified using AS-OCT. The defective incision group showed shorter IL and larger incision angles [false discovery rate (FDR) - p<0.05]. Changes in CT at incision site were more pronounced for the defective incision group (FDR - p<0.05). Some SIA parameters were related to the certain specific CCI features, especially IL (FDR - p<0.05). Both groups exhibited significant increased 6mm posterior corneal tHOAs at 1month (Bonferroni corrected - p<0.01) and the defective incision group showed increased 6mm posterior tHOAs at 6months (Bonferroni corrected - p=0.023). There were characteristic correlations between Zernike terms and CCI features including IL, CT, Dis-En/Ex, and incision angles at 1month, especially over 6mm zone. The CCI deformities can affect corneal recovery and induce more HOAs at 1month postoperatively. Such effects became minor, but could persist until 6months. The IL combined with Angle-En/Ex was important factor influencing CCI integrity and corneal optical quality.

Randomized Controlled Trial of varied incision sites in Manual Small Incision Cataract Surgery done in a Medical College Hospital in Kancheepuram District, Tamil Nadu, India

Aim: To compare visual outcome, postoperative surgically induced astigmatism (SIA), andpostoperative complications of superior and temporal scleral incision in manual small incisioncataract surgery (MSICS). Materials and Methods: A Prospective Randomized, parallel-group,active-controlled Trial Study of 80 cases of senile/pre-senile cataract. 40 cases were randomlyassigned (computer-generated randomization) to superior incision and 40 cases to the temporalincision. Results: The majority of patients (38 patients- 47.5%) were in the age group of 56-65years. The next common age group was 66-75 years(31 patients-38.75%). In the superior MSICSgroup, the majority of patients (28 patients-70%) had a moderate post-operative unaided visualacuity of 6/18-6/12. In the temporal MSICS group, majority of patients(33patients-82.5%) had agood post-operative unaided visual acuity of 6/9-6/6. The mean surgically induced astigmatism(SIA)in the superior MSICS group was 1.12 and in the temporal MSICS group was 0.45 with a differenceof 0.67. The SIA values were analyzed using the unpaired T-test which showed a value of 9.967which was statistically significant(P value of 0.0001). Conclusion: This study has shown that thetemporal approach for Manual small incision cataract surgery(MSICS) has less postoperativeastigmatism and better postoperative unaided visual acuity compared to the superior approach.

Incidence, management, and outcome of complex cataracts in a tertiary eye set up

Aim: To study the incidence, management, and outcome of complex cataract cases in a tertiary eyecare center. Material and methods: Retrospective observational study with analysis of recordsdone for patients who were operated on for complex cataract from December 2019 to February2020. Results: 300/10,000 patients had complex cataracts requiring additional surgical skills,advanced equipment, and better patient counseling. 5.3% (16/300) of patients needed intracameraladrenaline whereas 1.3% (4/300) needed Visco mydriasis. A capsular tension ring was implanted in4.3%(13/300) of patients. 4% (12/300) underwent sphincterotomies whereas 2% (6/300) had toundergo synechiolysis. Iris hooks were used in only 0.6% of patients (2/300). Posterior capsularrent was seen in 1.6%(5/300) which was managed by placing a Posterior chamber IOL in the sulcus.2.6% (8/300) had implantation of the iris-claw lens and 2.3% (7/300) were left aphakic forsecondary IOL to be implanted at a later date. The visual outcome was better than 6/18 in 76% ofpatients. 24% of patients had an improvement in their visual acuity by a line or 2 but was less than6/18 due to corneal degenerations, corneal scarring, Retinal pathologies, and colobomas.Conclusion: Although these cataracts demand more expertise on behalf of the surgeon, theoutcome can be very rewarding if done with proper planning. The knowledge of small incisioncataract surgery is highly valuable in such situations.

Incidence, management, and outcome of complex cataracts in a tertiary eye set up

Aim: To study the incidence, management, and outcome of complex cataract cases in a tertiary eyecare center. Material and methods: Retrospective observational study with analysis of recordsdone for patients who were operated on for complex cataract from December 2019 to February2020. Results: 300/10,000 patients had complex cataracts requiring additional surgical skills,advanced equipment, and better patient counseling. 5.3% (16/300) of patients needed intracameraladrenaline whereas 1.3% (4/300) needed Visco mydriasis. A capsular tension ring was implanted in4.3%(13/300) of patients. 4% (12/300) underwent sphincterotomies whereas 2% (6/300) had toundergo synechiolysis. Iris hooks were used in only 0.6% of patients (2/300). Posterior capsularrent was seen in 1.6%(5/300) which was managed by placing a Posterior chamber IOL in the sulcus.2.6% (8/300) had implantation of the iris-claw lens and 2.3% (7/300) were left aphakic forsecondary IOL to be implanted at a later date. The visual outcome was better than 6/18 in 76% ofpatients. 24% of patients had an improvement in their visual acuity by a line or 2 but was less than6/18 due to corneal degenerations, corneal scarring, Retinal pathologies, and colobomas.Conclusion: Although these cataracts demand more expertise on behalf of the surgeon, theoutcome can be very rewarding if done with proper planning. The knowledge of small incisioncataract surgery is highly valuable in such situations.

A clinical study to evaluate incidence of dry eye following cataract surgery

Introduction: Post cataract surgery dry eye in the susceptible population can adversely impact visual outcome and overall patient comfort. There are varying reports on the incidence of post cataract surgery dry eye depending on patient population and surgical technique. This study has evaluated the incidence and factors causing dry eye following phacoemulsification, small incisional cataract surgery (SICS) and conventional extracapsular cataract surgery (ECCE). Materials and Methods: Patients with cataract in the age group of 40 to 80 years with normal ocular surface and schirmers test at baseline were followed up after cataract surgery with schirmers recording at 1 month and 3 months. Pre and post- surgery schirmers values were compared for estimation of dry eyes. Results: A total 390 patients underwent cataract surgery with an overall post surgery residual dry eye incidence of 22.1% (95% CI 17.94 to 26.17) at the end of 3 months follow up. Of these 31% had mild, 67% had moderate and 2% had severe dry eye. A higher incidence was seen in SICS as compared to phacoemulsification. A statistically significant association was noted between dry eye and diminution of vision (p = 0.001). Keywords: Dry eye, Extra capsular, Phacoemulsification, Small incision, Schirmers test.

COMPARISON OF VISION OUTCOMES BETWEEN SICS (SMALL-INCISION CATARACT SURGERY) AND PHACOEMULSIFICATION IN CATARACT SURGERY

Objectives: The main objective of the study is to compare the vision outcomes between small-incision cataract surgery (SICS) and phacoemulsification (PHACO) procedures, to compare the quality of life (QOL) before surgery and after surgery, to improve the patient’s knowledge of their disease condition, and to increase medication adherence after the surgery.&#x0D; Methods: A prospective observational study was conducted for 6 months. About 100 patients were enrolled in the study according to the study criteria. Different scales ([visual function questionnaire] VFQ 25, QOL scale [QOLS] by Schalock and Keith, Morisky Adherence Scale -8 items) were scored from the patient’s profile and treatment chart by communicating with physicians, counseling the patients.&#x0D; Results: One hundred patients were assessed before and after cataract surgery and follow-up was made for 1 month. Overall, vision-related QOL was significantly improved in PHACO than SICS patients. National Eye Institute VFQ 25 was assessed on day 7 and day 30 where we have observed a statistically significant improvement in the PHACO group of patients than in SICS. Their medication adherence scores were categorized into a high, medium, low category, and most of the SICS patients remained in the medium category, whereas the number of patients increased from medium to high category in PHACO patients.&#x0D; Conclusion: We concluded that PHACO is better than small incisional cataract surgery due to its small and self-sealing incision, which requires no stitches in most cases, with minimum complications the patient heals faster and recovers rapidly.

Site of clear corneal incision in cataract surgery and its effects on surgically induced astigmatism

Clear corneal incision (CCI) is a commonly used surgical approach in cataract surgery. In this prospective study, we evaluated the effect of CCI site on surgically induced astigmatism (SIA) and other postoperative astigmatic changes. CCIs were constructed based on the steep meridian of the total corneal refractive power in the 4.0-mm-zone (TCRP4.0), and patients were divided into four groups: temporal, superotemporal, superonasal, and superior according to the site of the incision. TCRP4.0 analysis demonstrated a statistically significant reduction of astigmatism with superior incisions (P < 0.001), and the combined mean polar values for SIA changed significantly in the temporal (Hotelling T2 = 1.977), superotemporal (Hotelling T2 = 0.544), superonsal (Hotelling T2 = 1.066), and superior incision groups (Hotelling T2 = 1.134) (all P < 0.001). The posterior axis alignment should be considered in cataract surgery with CCI, and the SIA is affected by axis rotation, and incision orientation.

Endophthalmitis Prophylaxis Study, Report 2: Intracameral antibiotic prophylaxis with or without postoperative topical antibiotic in cataract surgery

Purpose:Intracameral antibiotic in cataract surgery has shown level I evidence as prophylaxis for postoperative endophthalmitis. Not much is known if one should also use topical antibiotics after intracameral injection. The purpose of the study was to determine efficacy of intracameral antibiotic with and without postoperative topical antibiotic in reducing the incidence of acute endophthalmitis after cataract surgery in rural India.Methods:A prospective comparative, non-randomized interventional study was designed in 15 rural centres in India. The study recruited 40,006 patients (n = 42,466 eyes), who underwent cataract surgery (phacoemulsification/small incision cataract surgery), and received intracameral antibiotic (cefuroxime/moxifloxacin). Postoperative topical antibiotic prescription was left to the choice of the treating physician, but they were encouraged not to use it in uneventful surgeries. Primary outcome measure was occurrence of acute clinical endophthalmitis within 6 weeks of surgery. Statistical analysis was done using STATA software v13.1 (StataCorp, Texas); P value of <0.05 was considered statistically significant.Results:In the study, 17,932 (42%) eyes received intracameral cefuroxime (ICC) and 24,534 (58%) eyes received intracameral moxifloxacin (ICM). Topical antibiotic was not prescribed to 17,855 (42%) eyes - 5723 (32%) eyes in ICC group and 12,132 (68%) eyes in ICM group. Acute clinical endophthalmitis occurred in 15 (0.035%) eyes - 1 / 3515 (0.028%) eyes and 1 / 2231 (0.045%) eyes that received and did not receive topical antibiotic, respectively. The difference in occurrence of endophthalmitis with/without topical antibiotics in each group (ICC: 0.016% and 0.017%; P = 0.958; ICM: 0.040% and 0.058%; P = 0.538) was not significant (P = 0.376).Conclusion:Supplementing intracameral antibiotic with topical antibiotic postoperatively did not impact the occurrence of acute post cataract surgery endophthalmitis in rural India

Assessment of corneal endothelial status post phacoemulsification with 1% ultrasound power in hard cataracts

Purpose: This study was conducted to discover that whether Co-axial micro incision cataract surgery using 1% ultrasound is superior to phacoemulsification using higher powers in terms of corneal endothelial safety over a period of one year. Materials and Methods: This comparative randomized study was conducted from 11-01-2014 to 03-31-2016. Patients with hard cataracts [5.0-6.9 of lens opacities classification system-III] were randomized into four groups and underwent cataract surgery using ultrasound powers of 1%, 5%, 10% and 20% respectively. Post-operatively they were assessed in terms of- corneal endothelial cell loss, co-efficient of variation of cell size, percentage of hexagonal cells and corneal thickness. The other parameters that were investigated were - frequency of significant posterior capsular opacification, best corrected visual acuity and Intraocular pressure variations. Results: This study found that application of 1% ultrasound power is superior to 5%, 10% or 20% power in phacoemulsification cataract surgery in terms of quantitative endothelial cell analysis (endothelial cell density, percentage of loss of endothelial cells, coefficient of variation, central corneal thickness and percentage of hexagonal cells) over one year follow up post-operatively. On comparison all parameters were found to be statistically significant when compared to the application of 20% power. Conclusion: Negative effects of ultrasound power (used in phacoemulsification) on corneal endothelial health have been well documented in the literature. We found that minimizing this power to 1% is effective in maintaining corneal endothelial viability without compromising the surgical experience and post-operative visual outcome. Keywords: 1% Ultrasound power, Coefficient of variation, Endothelial cell density, Percentage hexagonal cells, Phacoemulsification.

Cross sectional study to evaluate the prevalence of changes in tear film and tear secretion after small incisional cataract surgery

Aims and Objectives: To clinically evaluate the prevalence of dry eyes after manual small incision cataract surgery based on signs and symptoms and, quantifying them using various test methods. Materials and Methods: Follow up of 150 patients who had undergone SICS was done at regular interval starting at 1st week post-operative and continued up to 3rd months. Evaluation is done by performing Schirmer’s test – I, TFBUT, Rose Bengal test followed by noting the symptoms which were relevant to the dry eyes. The observations were analyzed and graded according to the severity of dryness. Results: Most of the patients had mild to moderate dry eye with male domination the female. Severe to very severe dry eyes was seen at 6th post-operative week, mild to moderate dryness of eyes was seen at 2nd & 3rd. weeks. Conclusion: Dryness of eyes is usually seen after small incision cataract surgery and majority being mild to moderate dryness of eyes. Worsening or aggravation of dryness occurred in 6th week’s post-operative interval. Post-operative management of cataract surgery should also include medication to deal with altered ocular surface tears film. Keywords: Cataract, Dry eye, Small incision cataract surgery, Schirmer’s test, Sclero corneal tunnel.