Manual Small Incision Cataract Surgery Research Articles

Should test for dry eyes be done before age-related cataract surgery?

Objectives: This study aimed to determine if tests for dry eyes should be done routinely before age-related cataract surgery. Materials and Methods: This was a hospital-based observational prospective study. Patients 50 years and above with age-related cataracts that met the inclusion criteria scheduled for manual small incision cataract surgery (MSICS) were assessed for dry eye disease (DED) before and after surgery. Numerical variables were described using the mean and standard deviation (SD) with a 95% confidence interval and P < 0.05. Results: A total of 81 patients were studied: 60.5% (49) males and 39.5% (32) females. The mean pre-operative Schirmer’s test value was 14.09 mm (SD = 10.7 mm). Post-operative schirmer’s test values were 18.12mm (SD = 11.81mm) at 1 week, 14.98mm (SD = 11.26mm) at 4 weeks and 16.20 mm (SD = 11.06 mm) at 6 weeks. Pre-operative mean tear break-up time (TBUT) was 10.05 (SD = 5.13 s), 9.46 s (SD = 4.18 s) at 1 week, 10.13 s (SD = 4.29 s) at 4 weeks and 9.80 s (SD = 4.33 s) at 6 weeks postoperatively. Lissamine green staining score (LGSS) Grade 0 was 80% at 1 week post-operative, Grade 0 increased to 85%, 90% at 4 weeks and 91% at post-operative 6 weeks. Conclusion: This study showed that DED is not associated with MSICS, and it is not associated with objective worsening of previously diagnosed DED. Testing for DED preoperatively plays a significant role in the pre-operative evaluation of patients and symptomatic expectations, but its testing before MSICS might not always be necessary.

Comparison of Visual Acuity Outcomes of Phacoemulsification and Small Incision Cataract Surgery

Background. The visual outcomes of phacoemulsification (Phaco) and manual small incision cataract surgery (MSICS) have been extensively studied, with research indicating that both methods are highly effective in restoring vision. Purpose. This study was aimed at comparing the visual acuity outcomes of the two surgical techniques. Methods. A total of 90 participants were scheduled for cataract surgery at Adetula Opticals & Eye Clinic, Oshodi-Isolo, Lagos State, Nigeria, from June to August 2023. The participants were divided into two groups of 45, a group was scheduled for Phaco (0.92 ± 0.65; 6/60-6/36) and SICS (1.32 ± 0.81; 3/60) logMAR. Visual acuities (VAs) were measured pre- and postoperatively. Results. The difference in mean VA pre-op of -0.40 (95% confidence interval (CI): -0.096, -0.71) between the two techniques was statistically significant (p = 0.000). There was no significant difference in the logMAR VAs between the techniques post-operatively (p = 0.06), although the visual outcome with the two methods showed the tendency of a better VA (0.11± 0.17 [6/9 - 6/6]) as opposed to that of the other two techniques (0.22 ± 0.32; [6/12 - 6/9]). Conclusion. Both techniques have been refined to a point where they provide comparable long-term visual outcomes, making the choice of method dependent on specific patient needs, surgeon expertise, and available resources.

Comparison of Mean Surgically Induced Astigmatism in Manual Small Incision Cataract Surgery Using Frown Vs Chevron Incision

Purpose: To compare the mean surgically induced Astigmatism(SIA) in Manual Small Incision Cataract Surgery (MSICS) using frown (inverted U) versus inverted V (chevron) incision. Study Design: Quasi experimental study. Place and Duration of Study: Hayatabad Medical Complex from 27th July 2018 to 27th January 2019. Methods: This study included 148 patients who were distributed into the Frown group (F) and Chevron group (C) by convenient sampling. Each group had 74 patients through block operative randomization. To eliminate bias, all the surgeries were performed by one surgeon having more than 5 years’ experience of MSICS. Pre-operative and Post operative keratometric readings were taken. SIA calculator was utilized, and data was analyzed through SPSS 26. Means and standard deviation for continuous variables like age and surgically induced astigmatism were calculated. Results: In Group F, mean surgically induced astigmatism was 1.14±0.65D and in Group C it was 0.87±0.55D. The independent T test revealed that the mean SIA was significantly lower in the Chevron group compared to the Frown group.The post operative visual acuities showed that the proportion of patients with postoperative 6/6 vision in the Chevron group was more as compared to group F. Conclusion: Chevron (inverted V) incision induces less postoperative mean surgically induced astigmatism than Frown (inverted U) incision in Manual Small Incision Cataract Surgery. These findings may have implications for cataract surgery techniques and may help in reducing postoperative astigmatism.

"Stamp the tunnel"- Innovative tool - for perfection in manual small incision cataract surgery.

Manual small incision cataract surgery (SICS) is a cost-effective and safe procedure offering comparable outcomes to phacoemulsification. It holds significance for outreach and economically disadvantaged patients in developing countries, while also being important for complex cataracts in developed nations. The SICS technique revolves around a three planar self-sealing sclero corneal tunnel (SCT), a critical element for rapid and suture-less healing. The tunnel's components include the incision, side pocket, internal entry, and depth each affecting astigmatism and successful nucleus delivery.[1-3] Various incision types are explored, with the frown incision yielding minimal astigmatism but posing challenges.[2,4] Inappropriate SCT leads on to high induced astigmatism, post op hypotony, and chances of infection. This video introduces "Tunnel stamp" which is a novel device designed to guide the incision length, internal entry line, and side pocket accuracy thus making a perfect SCT particularly for novice surgeons, who often encounter intraoperative and postoperative complications due to inappropriate SCT. The device is produced through 3D printing with thermoplastic polyurethane (TPU), an easily available and economically feasible material. The prototype's practicality is demonstrated through successful wet lab trials on goat eyes and subsequently on human eyes. The device is aligned using a limbus-matching step and a sterilized marker pen. This device has unique advantage to take care of the three aspects of SCT, that is, incision, side pocket, and internal entry. One can have custom-made guarded knife to perform scleral groove in optimum depth, which is another important dimension of SCT. Future developments involve creating the tunnel stamp in transparent flexible silicon to enhance alignment accuracy. Given the diversity of cataract types, multiple sizes of the device are envisioned to accommodate nucleus size variability and different stages of cataract development. To aid novice surgeons, two variations of incision guides (straight and frown) are proposed for immature and harder cataracts reducing induced astigmatism. Overall, this innovative tunnel stamp aims to enhance SICS outcomes, enabling more precise and consistent SCT creation while addressing challenges posed by various cataract types and surgeon experience levels. https://youtu.be/yzV-UC4jwPg.

Fallen Yet Beautiful

Iridodialysis can occur due to blunt trauma or intraocular surgeries. Symptoms include glare, photophobia, eye pain, Diplopia. Signs include elevated Intraocular Pressure , Hyphema. In this report, we describe a case of total Iridodialysis during manual small incision cataract surgery. The disinserted Iris was left insitu and on postoperative day 1, the Iris was in place without getting crumpled or obstructing the visual axis. The postoperative 6 week follow up has the same picture where Iris tissue remained the same without getting necrosed. This is an unusual presentation of the Iris tissue

Manual Sutureless (MSICS) Cataract Surgery and Corneal Astigmatism

The most frequent preventable cause of blindness worldwide is cataracts. Manual Small Incision Cataract Surgery (MSICS) is still very much in use, even though cataract surgery is always changing. The resurgence of MSICS can be attributed to its low cost and safety, as it primarily uses easily sterilizable equipments and does not require sophisticated technology. This study aims to assess corneal astigmatism and manual sutureless (MSICS) cataract surgery after a month of follow-up. Forty individuals with cataract diagnoses were enrolled in this prospective study. During the procedure, a posterior chamber intraocular lens (IOL) implantation was done in addition to a superior manual minor incision under local anesthesia. The findings indicated that 15% or so of the patients experienced astigmatism following surgery. Also the findings revealed that sphere and cylinder refraction was significantly influenced by surgery. The means of sphere refraction before and after surgery were 3.93±6.37 and 0.93±0.98 D, while the corresponding means for cylinder refraction were 1.37±1.08 and 1.94±1.18 D. The results showed that means preoperative and postoperative Keratometry of cornea (K1) were 43.09±1.21 and 43.37±1.42 mm, while the corresponding means of Keratometry (K2) were 43.97±1.35 and 44.49±1.59 mm. The study concluded that the length of the superior incision (6.0 mm) may have contributed to the higher mean SIA than reported in other studies. However, more research is required to determine the impact of incision size on surgically produced astigmatism.

Phacoemulsification to MSICS: A transfer of skills study in a simulated environment.: Transfer of phacoemulsification surgical skills to MSICS.

To investigate if phacoemulsification experience impacts and transfers to the skill acquisition of novices in manual small incision cataract surgery (MSICS) within a simulation environment. Copenhagen Academy for Medical Education and Simulation, Denmark. Prospective controlled experimental study. The study included 29 residents or specialist in ophthalmology with no prior MSICS experience. Participants were required to either have 1) proficiency on the EyeSi surgical simulator (PG; phaco group) or 2) no prior extensive exposure to the EyeSi simulator or any phacoemulsification surgery experience as a primary surgeon (CG; control group). Possible skill transfer was assessed using a test on the HelpMeSee virtual-reality simulator, including nine modules and 30 steps (points). A pass/fail score was determined at 20 points (out of 30 points). Performance scores were analyzed using independent samples t-tests, pass rates using Fisher's exact test, and individual modules using Fisher-Freeman-Halton analysis. The PG performed significantly better in terms of overall performance score (mean SD, PG; 21.8 points 2.3 versus CG; 18.9 points 2.2, p = 0.002, t-value = -3.39) and pass rates (PG; 72 % versus CG; 22%, p = 0.018). The sub-analysis for individual modules demonstrated significant differences exclusively in the capsulorhexis and cortex removal modules. The results suggest a positive inter-procedural transfer of skills between phacoemulsification and MSICS. Pretraining and experience in phacoemulsification demonstrated a significant effect on the performance of MSICS within a simulation environment. These findings suggest that phacoemulsification experience provides an advantage before MSICS training in surgical residency programs.

Evaluation of the impact of short term manual small incision cataract surgery (MSICS) training program on trainees with varying prior surgical experience using international council of ophthalmology-ophthalmology surgical competency assessment rubrics (ICO-OSCAR).

To assess the learning curve of MSICS in three different groups of trainees with varying prior MSICS experience. To evaluate the effectiveness of ICO OSCAR for objective assessment of surgical skill transfer. Ninety-five MSICS trainees were divided into three groups as 1st year resident, fellow and external trainee. Each group were evaluated for their surgical skill acquisition during one month MSICS training program using ICO-OSCAR. Each trainee performed an average of 19 surgeries. The progress in the learning curve of the three groups of trainees was analyzed by evaluating the mean scores in sets of five consecutive cases. Complications during the training period were also noted. The study evaluated a total of 1842 cases. The fellows and external trainees, with prior MSICS experience, had an initial mean score of 57.57 ± 16.16 and 56.86 ± 17.82 respectively, whereas the 1st year resident group had a relatively low initial mean score of 45.91(p = 0.009). The difference in mean scores between the 1st year resident group and other groups significantly reduced towards the end of training. The most common complications made by 1st year residents were in sclero-corneal tunnel construction. The external trainee group had statistically significant higher rates of zonular dialysis in the study. ICO-OSCAR is an effective tool for assessing MSICS training program. Structured short term MSICS surgical training program is effective in surgical skill transfer, especially in novice surgeons.

Learning curve of resident performed phacoemulsification versus manual small incision cataract surgery at a regional ophthalmic institute in western India

Learning curve of resident performed phacoemulsification versus manual small incision cataract surgery at a regional ophthalmic institute in western India

A clinical study of the neodymium-doped yttrium–aluminium–garnet laser posterior capsulotomy: Visual outcome and early complications

Objectives: The objectives of this study were as follows: To study the efficacy of neodymium-doped yttrium–aluminium–garnet (Nd:YAG) laser capsulotomy in posterior capsular opacification (PCO) by analysing the visual outcome. To study any other early complications seen following Nd:YAG laser capsulotomy. Materials and Methods: A prospective interventional study was done in the Department of Ophthalmology of a tertiary care hospital in the Marathwada region of Maharashtra. A total of 55 eyes developing PCO after cataract surgery were included in the study from November 2022 to October 2023. Routine pre-laser evaluation using slit-lamp biomicroscopy, intraocular pressure (IOP) measurements and dilated fundus examination was done. Thirty-eight patients had undergone manual small incision cataract surgery with polymethyl methacrylate intraocular lens (IOL) implantation and 17 patients had undergone phacoemulsification surgery with acrylic foldable IOL implantation. The patient was then followed up on Days 2, 7, 30, and 3 months to look for any early post-laser complications. Results: A total of 55 eyes were included in the study. The age group of patients included in the study is from 50 to 75 years. Most of the patients 21 were in the age group of 56–60 years. Twenty (36%) were male and 35(63%) females; thus, female preponderance is seen. On retro-illumination of the slit lamp, 9 (16.3%) patients had severe PCO having vision ≤3/60, 24 (43.6%) patients had moderate PCO with vision 3/60–6/60 and 22 (40%) patients had mild PCO with vision 6/60–6/18. Forty-seven patients (85%) had visual acuity of more than 6/12 at the end of 3 months. In most patients, an appropriate central capsulotomy was achieved within the total energy of 60 mJ but in three cases more than 100 mJ energy was used due to the thick posterior capsule. About 6% of subjects showed increased IOP of more than 21 mm Hg but returned to normal level within 1 week. Mild uveal reaction in the form of anterior chamber flare and cells was seen in 2% of cases. IOL pitting was seen in 5 (8%) cases. One (2%) patient had a vision of 3/60 and a significant increase in macular thickness at day 7 post-laser which decreased at 1 month follow-up by appropriate treatment. No evidence of any retinal tears or retinal detachment seen. Conclusion: PCO is a common delayed complication seen after cataract surgery. This opacification decreases the vision of the patient to affect day-to-day activities. It can be easily managed on an outdoor basis by a non-invasive and effective Nd:YAG laser posterior capsulotomy procedure. This procedure has been shown to increase the visual outcome and has fewer complications which can be managed easily.

A Comparison of Functional Endothelial Changes between Phacoemulsification with PCIOL and Manual Small Incision Cataract Surgery with PCIOL

Intraocular surgery e.g., cataract surgery with PCIOL implantation is one of the leading causes of corneal endothelial injury and change in the functionality of the cornea. This observational study was conducted in the Department of Ophthalmology of Combined Military Hospital (CMH), Dhaka Cantonment, Dhaka, Bangladesh, between January and July of 2016, to assess and compare functional changes in cornea (i.e., endothelial thickness) after phacoemulsification with posterior chamber intraocular lens (PCIOL) implantation and manual small incision cataract surgery (MSICS) with PCIOL implantation. A total of 80 patients of age-related cataract were randomly selected based on inclusion and exclusion criteria. All patients underwent complete ophthalmic evaluation pre- and post-operatively (at day 1, after 1 week and 3 months) specifically for observation of the endothelial changes in cornea. Specular microscopy was done to assess corneal endothelial change. The mean central corneal thickness was increased at day 1 (564.71±22.45μ vs. 555.10±40.57μ), after 1 week (539.43±22.16μ vs. 535.08±38.87μ) and 3 months (523.49±21.29μ vs. 520.05±33.68μ) after phacoemulsification and MSICS from their preoperative value (508.72±23.96μ vs. 503.62±32.06μ) respectively. However, the differences were not statistically significant between two groups (P>0.05). The mean percentage of central corneal thickness change at day1, after 1 week and after 3 months following cataract surgery were found 11.01±6.30% and 10.22±26.54% at day 1, 6.04±7.52% and 6.25±21.24% after 1 week, 2.90±11.14% and 3.26±5.05% after 3 months in phacoemulsification and MSICS cases respectively. However, no statistically significant difference was observed in percentage of central corneal thickness change of both groups (P>0.05). To summarize, an increased central corneal thickness was observed after phacoemulsification and SICS from their preoperative values. Mugda Med Coll J. 2024; 7(1): 14-18

Clinical Outcome of Manual Small-incision Cataract Surgery in Patients with Phacolytic Glaucoma

Abstract Aim and Objective: To study the clinical outcome of cataract surgery in patients with phacolytic glaucoma. Materials and Methods: This is a hospital based prospective interventional study done on 50 eyes of 50 cases of phacolytic glaucoma conducted over one year. Following initial medical management, patients underwent lens extraction through manual small incision cataract surgery (SICS). Clinical examination, best corrected visual acuity and intraocular pressure were noted preoperatively as well as postoperatively. Result: A total of 50 patients were enrolled in this study with female to male ratio of 1.5:1. The mean age of presentation was 62.48 years. Preoperative vision in the affected eye was only perception of light in all of them and IOP measured at presentation was <30 mm Hg in 11 (22%), 30-40 mm in 17 (34%), 40-50 mm in 14 (28%) and >50 mm in 8 (16%). Thirty patients (60%) had good vision in fellow eye due to pseudophakia. The average duration between the first and second eye surgery was 1-3 years. 94% of our patients were from rural areas. All patients presented within one week of the onset of symptoms. All patients underwent manual small incision cataract surgery with rigid IOL implantation in 35 patients (70%), whereas 15 cases (30%) were left aphakic and planned for secondary IOL at a later date. Intraoperative complications noted were zonular dehiscence in 38%, anterior capsular calcification which led to difficulty in anterior capsulorhexis in 32%, peripheral rhexis runoff in 20%, subluxated lens in 12% and posterior capsular rupture in 14%. BCVA at the end of 1 month was >6/12 in 21 patients (42%), 6/12-6/18 in 14 patients (28%), and <6/18 in 15 patients (30%). Among the 15 patients with vision <6/18, 14 had low vision due to aphakia, and 1 had cystoid macular edema which was treated with systemic and oral steroids and topical non-steroidal anti-inflammatory agents. Conclusion: We concluded that lens-induced glaucoma is a cause of preventable blindness, particularly in elderly patients. Factors such as ignorance, socioeconomic challenges, lack of awareness, absence of an escort, and good vision in the other eye contribute to delayed presentation. Early diagnosis and treatment, along with sequential cataract surgery, are crucial for achieving better visual outcomes and preventing complications like lens-induced glaucoma.

Capsular bag distension syndrome with sulcus IOL acting as a seal

Capsular bag distension syndrome (CBDS) is a rare complication following cataract surgery with posterior chamber intraocular lens (IOL) implantation. We describe the case of a 68-year-old female who developed early-onset CBDS of her left eye after manual small-incision cataract surgery with implantation of posterior chamber IOL in the sulcus (Excel PMMA IOL (polymethyl methacrylate), Manufactured by Excel Optics (P) Limited, Chennai). The patient had an uneventful cataract surgery performed by a resident in training. Her immediate postoperative uncorrected vision was 20/40, but it decreased to finger counting 1 m on postoperative day 7, for which she presented back to hospital. Slit-lamp examination revealed a quiet anterior chamber without any cells–flare with IOL in the sulcus with a relatively smaller capsulorhexis of about 5 mm, and IOL optic was covering the capsulorhexis in a symmetric fashion, thus causing a block. Distension of capsular bag was further confirmed by Anterion anterior segment optical coherence tomography (Heidelberg Engineering Technology, Germany), which showed a confined hyperechogenic fluid trapped between the IOL and the posterior capsule. She was diagnosed with CBDS secondary to retention of turbid fluid. Phased treatment was done; neodymium-doped yttrium aluminum garnet capsulotomy was tried in the first attempt, but failed as the posterior capsule was far too behind. This was followed by anterior chamber wash with redialing of the lens in the bag, which thereby improved vision to 20/20 (best corrected visual acuity) at 1-week postoperatively. Even with IOL in the sulcus, the postoperative CBDS may rarely happen at any point of time with a small capsulorrhexis and an intumescent mature cataract. Immense cortex wash should always be kept in mind in such a case, as the liquefied cortex is sometimes stuck at the equator and a little more duration of irrigation is required in such scenarios. Hence, complete clearance of turbid fluid of intumescent mature cataract variety also holds due importance similar to the need of removing viscoelastic substance to prevent CBDS.

A Study on Refractive Outcome Following Manual Small Incision Cataract Surgery with Rigid PCIOL

Introduction: Cataract is a significant and increasing global problem with vast economic and social implications[1]. It is the principal cause of blindness in India accounting for 62.6% (92). The prevalence of blinding cataract will only increase as people live longer, so cataract will continue to be, by far, the most important treatable cause of blindness. It is estimated that the present number of 20 million of cataract blind will double by year 2030.[2] . Materials and Methods: Study design: Cross sectional observational study Source of data: All the patients admitted with small incision cataract surgery (SICS) with PCIOL implant, in the department of Ophthalmology Rajarajeshwari Medical College and Hospital, Bangalore Study period: 18 months (Jan 2021- June 2022) Sample size: 200 patients. Results and Observations: In our study, at 1st post operative week, most patients had visual acuity score of better than 6/9 and least had less than 6/60 score. A follow up of patients at 2nd week, 6th week and end of 6th week showed that visual acuity improved at 2nd and 6th post-operative weeks.. Most patients were in the refraction range of < -0.50. Conclusion: From our study we conclude that the uncorrected visual acuity of cataract patients improved in the early and late post-operative weeks, after undergoing Manual Small Incision Cataract Surgery with Rigid PCIOL (MSICS) to a great extent. MSICS can be accepted as an alternative to phacoemulsification in developing countries like India. Keywords: Cataract, Small incision, Astigmatic, Visual outcome

Comparing the impact of surgical expert versus non-ophthalmologist instructors on virtual-reality surgical performance: A randomized controlled trial.

To compare Manual Small Incision Cataract Surgery (MSICS) microsurgical performance in course participants who received virtual reality simulation-based training by either a surgical expert or a non-ophthalmologist instructor. Copenhagen Academy for Medical Education and Simulation, Copenhagen, Denmark. Randomized controlled trial. Residents and specialists in ophthalmology with no prior MSICS experience were included to receive virtual reality simulation training in MSICS using the HelpMeSee simulator. The participants were randomly allocated to receive training from either an experienced MSICS surgeon or a non-ophthalmologist, also known as near-peer teaching. The performances of the participants were evaluated at baseline and post-training using a MSICS proficiency-based test with evidence of validity. Thirty participants were included in the study and 29 completed the course. There was no significant difference in final test score between the two groups (p = 0.13). The performance score of both groups of participants increased significantly after receiving the training (p < 0.001). All participants passed the proficiency-based test after receiving the training. We found no significant difference in surgical proficiency-level whether the participants were trained by a surgical expert or a non-ophthalmologist instructor for MSICS in a virtual-reality based setting. The findings of this study suggest that near-peer teaching within microsurgical performance potentially could be applied with teaching outcomes comparable to a surgical expert-instructor.

A comparative lens: Manual small incision cataract surgery versus phacoemulsification

A comparative lens: Manual small incision cataract surgery versus phacoemulsification

Manual small incision cataract surgery – need for literature backup

Manual small incision cataract surgery – need for literature backup

Teaching of manual cataract extraction in ophthalmic surgical training programmes

BackgroundManual cataract extraction techniques such as extracapsular cataract extraction (ECCE) or manual small incision cataract (MSICS) surgery have been replaced by phacoemulsification cataract surgery. Surgical training opportunities for manual techniques of cataract extraction are limited in modern surgical training programmes.AimsThis study evaluated the current trends of ECCE/MSICS training opportunities amongst trainees and trainers in the Irish Ophthalmic Surgical Training Program.MethodsAn electronic survey was distributed to all ophthalmic surgical trainees and consultants in the country. It addressed the experience and exposure to ECCE/MSICS.ResultsNineteen of 33 (57%) trainees and 29 of 55 (55%) of consultants completed the survey. Twelve of 19 (63%) trainees viewed an ECCE procedure performed live. Twenty-seven of 29 (93%) consultants performed an ECCE procedure during their surgical career; 8 of 27 (30%) performed an ECCE within the last 1–3 years. Fourteen of 19 (74%) trainees stated they do not feel confident converting from phacoemulsification to ECCE independently. Sixteen of 19 (89%) trainees believe manual cataract extraction training should be included in their surgical training. Nineteen of 29 (65%) consultants believe training in manual cataract extraction should be part of the surgical training programme.ConclusionsThere is a paucity of manual cataract extraction being performed in Ireland, limiting live surgical training in this technique. This survey highlights the limited experience of trainees in this valuable skill that is occasionally required for a successful surgical outcome. The authors conclude that wet laboratory simulated training of manual cataract extraction will bridge this gap.

Comparison of Surgically Induced Astigmatism Following Manual Sics: Superior and Temporal Approach

Aim: The operable cataract cases in the developing world is high compared to the cataract surgical rate, and economical and effective methods are required to deal with this curable blindness, in order to provide the highest achievable uncorrected distance visual acuity. This study aimed to compare the surgically induced corneal astigmatism in patients undergoing manual small incision cataract surgery by superior (s-MSICS) and temporal (t-MSICS) scleral tunnel incisions. Methods: Prospective, interventional cases series of 60 eyes of 60 patients. Uncorrected distance visual acuity (UDVA), mean keratometry (KMean) and surgically induced astigmatism (SIA) were the main outcome measures which were compared between the two groups, s-MSICS and t-MSICS. Results: The mean patient age was 58.60 ± 7.11 years and 59.63 ± 8.39 years in the s-MSICS and t-MSICS groups respectively. Uncorrected distance visual acuity (UDVA) on day 90 was 0.27 ± 0.14 logMAR in the s-MSICS group and 0.18 ± 0.16 logMAR in the t-MSICS group (p=0.05). At the final assessment s-MSICS had 1.43 ± 0.99D of SIA and t-MSICS had 0.76 ± 0.66D of SIA (p=0.02). Four patients in the s-MSICS group and 25 patients in the t-MSICS group had WTR astigmatism (p&lt;0.001). Likewise, there were 26 cases of ATR and one case of ATR in the s-MSICS and t-MSICS respectively (p&lt;0.001). Conclusion: In this prospective study, t-MSICS had significantly lesser surgically induced astigmatism than s-MSICS. The temporal incision decreased against the rule astigmatism, as well, which is the astigmatism prevalent in the adult population.

Study of safety and efficacy of sub-Tenon and subconjunctival anesthesia in manual small-incision cataract surgery for hard-grade cataracts.

The purpose was to study the safety and efficacy of sub-Tenon and subconjunctival anesthesia in manual small-incision cataract surgery (MSICS) in patients with hard-grade cataracts. The design of the study was a prospective, observational, and randomized control study. A total of 196 eyes, including 98 eyes in the subconjunctival anesthesia group (group A) and 98 eyes in the sub-Tenon anesthesia group (Group B), undergoing MSICS were enrolled in the study. A single surgeon performed all the surgeries. Intraoperative and postoperative pain scores, patient comfort, surgeon's satisfaction, and intraoperative complications were examined. The mean age of patients in Group A was 66.64 ± 9.95 years and that of patients in Group B was 64.52 ± 9.46. No statistically significant difference was noted in the intraoperative (P = 0.54) and postoperative pain (P = 0.66) scores between the two groups. There was no pain (0 score) in 30% of patients in Group A and 35% of patients in Group B intraoperatively. The average surgical time (P = 0.66) and surgeon's comfort (P = 0.34) were not statistically significant. The mean corneal haze was 0.054 ± 0.12 in group A and 0.065 ± 0.22 in group B (P = 0.45). Two patients in group A required supplemental anesthesia. There were no surgical complications that could compromise visual outcomes. No patients in either group showed alterations in vital parameters or required intravenous sedation. Both techniques of anesthesia are safe and effective for performing MSICS in hard-grade cataracts. However, it is prudent to choose a technique according to the surgeon's requirements.