Manual Small Incision Cataract Surgery Research Articles

Teaching of manual cataract extraction in ophthalmic surgical training programmes.

Manual 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techniques such as extracapsular cataract extraction (ECCE) or manual small incision cataract (MSICS) surgery have been replaced by phacoemulsification cataract surgery.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. This study evaluated the current trends of ECCE/MSICS training opportunities amongst trainees and trainers in the Irish Ophthalmic Surgical Training Program. An electronic survey was distributed to all ophthalmic surgical trainees and consultants in the country. It addressed the experience and exposure to ECCE/MSICS. Nineteen 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. There 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<0.001). Likewise, there were 26 cases of ATR and one case of ATR in the s-MSICS and t-MSICS respectively (p<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.

How severe are ocular surface abnormalities 3 months following cataract surgery? An observational study

Aim: The aim of this study was to detect the pattern of ocular surface changes seen 3 months after undergoing phacoemulsification or manual small-incision cataract surgery (SICS) and match them with age-matched normal individuals. Materials and Methods: A prospective observational study was conducted in the ophthalmology outpatient department (OPD) in a tertiary care center. Consecutive patients coming to OPD were grouped into three study groups – Group 1 included 25 patients who had undergone manual SICS, Group 2 included patients who had undergone clear corneal phacoemulsification surgery, and Group 3 included age-matched controls. Patients with ocular and systemic diseases were excluded. All the patients underwent Schirmer’s test, tear film breakup time, ocular surface staining, and ocular surface disease index score. One-way analysis of variance test was used for the comparison of data, and P = 0.05 or less was considered to indicate a significant difference. Results: Significant dry eye changes after 3 months of cataract surgery were present in SICS and Phacoemulsification groups as compared to age-matched normals (p-value < 0.05), but there was no significant difference between SICS and PHACOEMULSIFICATION surgery groups in the incidence of dry eye incidence. Conclusion: Dry eye symptoms are significant following cataract surgery irrespective of the type of surgery either SICS or phacoemulsification.

Comparison of pupil dilation in manual small incision cataract surgery using topical versus intracameral mydriatic agents – A randomised controlled trial

Objectives: The purpose of this research is to assess and compare the efficacy of an intracameral mydriatic solution with conventional topical agents in the completion of manual small incision cataract surgery (MSICS) in a black population. Materials and Methods: This randomised controlled trial was conducted among 102 patients undergoing MSICS under sub-tenon’s block. Mydriasis in the topical group was achieved with a pre-operative topical dilating combination of tropicamide 0.8% and phenylephrine 5% while surgery was commenced in patients in the intracameral group without dilation, and mydriasis was achieved intraoperatively with an intracameral solution of lidocaine 0.5% and adrenaline 0.001%. Pupil sizes were measured serially, before, and at four different junctures during surgery. The proportion of patients needing supplementary mydriasis in either group was noted, as well as post-operative pinhole visual acuity (VA). Data analysis was carried out using the Statistical Package for the Social Sciences Statistical Product and Service Solutions(SPSS) version 25.0 (IBM, Chicago, Illinois). The level of statistical significance was set at P < 0.05 at a 95% confidence interval. Results: Mean pupil diameter before dilating and blocking was 2.5 ± 0.6 mm in the topical group and 2.5 ± 0.7 mm in the intracameral group (P = 0.752). This increased to 7.7 ± 1.1 mm and 7.4 ± 0.8 mm, respectively (P = 0.134), after administering either mydriatic agents. After that, mean pupil diameter progressively reduced in both groups but was significantly higher in the intracameral group at each point of measurement (P < 0.05). Postoperatively, there was no significant difference in the VA between the two groups (P < 0.05). Conclusion: Using an intracameral mixture of lidocaine and adrenaline gives adequate mydriasis for the successful completion of MSICS without pre-operative dilation.

Starting manual small incision cataract surgery as a phaco surgeon

Starting manual small incision cataract surgery as a phaco surgeon

Fusion-Flanged Intrascleral Intraocular Lens Fixation Technique: Simple, Safe, Efficient.

To develop a new, sutureless intrascleral intraocular lens (IOL) fixation technique based on the Yamane double-needle and Canabrava 4-flanged techniques. The Fusion-Flanged technique involves using a 7-0 polypropylene suture loop threaded through the eyelets of the IOL. Afterward, both ends of the suture are passed outside the eye through a 27-gauge needle. This technique creates a single flange by joining the 2 suture ends through handheld cautery, and this flange is then embedded into the scleral tunnel to securely fix the IOL in place. This technique was performed on a total of 7 aphakic patients. Four of them had encountered complications following manual small incision cataract surgery, while the remaining 3 experienced complications after phacoemulsification. The results indicated a significant improvement in visual acuity, with mean preoperative and postoperative corrected distance visual acuities of 0.77 ± 0.11 and 0.27 ± 0.08 (logarithm of the minimum angle of resolution [logMAR] units), respectively. The Fusion-Flanged intrascleral IOL fixation technique offers improvements in simplicity, safety, and the overall efficiency when compared to existing sutureless intrascleral fixation techniques. Notably, this technique is versatile and can be applied to both non-foldable and foldable IOLs.

The Outcome of Manual Small Incision Cataract Surgery (MSICS) Using Ruit’s Technique in Phacomorphic and Phacolytic Glaucoma at Nan Hospital, Thailand

Objective: To evaluate the visual outcome and complications of manual small incision cataract surgery (MSICS) using Ruit’s technique in the treatment of patients with phacomorphic and phacolytic glaucoma. Materials and Methods: The medical records of 150 eyes in 147 patients with phacomorphic and phacolytic glaucoma who underwent MSICS by the Ruit’s technique between January 2009 and May 2022 at Nan Hospital, were retrospectively reviewed. Out of these 150 eyes from the 147 patients, 58 eyes from 58 patients missed the six-week follow-up, and 14 eyes from 14 patients had pre-operative vision impairing pathology. Records were analyzed of the patients with pre-operative, post-operative uncorrected visual acuity (UCVA), intraocular pressure (IOP), operative time, intraoperative difficulties and complications, and post-operative complications and astigmatism in the second and sixth week after surgery for the 78 eyes out of 75 patients. Results: Seventy-eight eyes of 75 patients treated by MSICS using Ruit’s technique with IOL implanted in the posterior chamber demonstrated no significant intraoperative or post-operative complications. The post-operative UCVA at the sixth-week follow-up was 20/70 or better in 76% of the phacomorphic glaucoma group and 64% of the phacolytic glaucoma group. In the sixth week after treatment, the mean post-operative astigmatism of the phacomorphic glaucoma group was –1.4±0.9 D and –1.3±0.7 D for the phacolytic glaucoma group. The mean post-operative IOP in the sixth week after surgery for phacomorphic glaucoma and phacolytic glaucoma were 10.7±3.7 mmHg and 9.8±4.3 mmHg, respectively. Conclusion: Manual small incision cataract surgery (MSICS) using Ruit’s technique is an effective method and excellent at controlling the IOP and achieving good visual acuity with a low rate of complications for patients with phacomorphic and phacolytic glaucoma. Keywords: Ruit’s technique; Manual small incision cataract surgery; Phacomorphic glaucoma; Phacolytic glaucoma

Visual outcome and complications of phacoemulsification and manual small incision cataract extraction for age related cataract

The purpose of this study is to compare visual outcome and complications of manual small incision cataract surgery (MSICS) with posterior chamber IOL implantation (PC-IOL) and phacoemulsification with posterior chamber IOL implantation for age related cataract. The study compares the visual outcome and complications of MSICS and phacoemulsification with PC-IOL performed in 80 eyes at M & J Western Regional Institute of Ophthalmology (M&J WRIO) Ahmedabad, by assessing post operative Best corrected Visual acuity (BCVA), Surgically Induced astigmatism (SIA) and complications. This was an Institutional based cohort interventional randomized, prospective study. MSICS and Phacoemulsification was performed on 80 eyes at M & J WRIO. The intraoperative complications were documented. The parameters that were examined on 1 postoperative day, 1 week, and 6 weeks postoperatively included uncorrected visual acuity, best corrected visual acuity (BCVA) at 6 weeks, intra ocular pressure by non -contact tonometry and keratometry at 6 weeks to rule out SIA.Statistical analysis was performed using chi square test. p value <0.05 was taken as significant.: MSICS & phacoemulsification had similar visual outcomes post-operatively. Phacoemulsification group produced less mean SIA (1.27 D) compared to MSICS group (1.29 D) and lesser (5%) complications than the MSICS group (10%). The comparison of all three parameters was not statistically significant between the two groups.: Visual outcomes, SIA and complications were comparably the same in MSICS & phacoemulsification. Therefore, MSICS can be excellent alternative to phacoemulsification.

Visual outcomes and risk factors of uveitis cataract eyes after phacoemulsification and manual small-incision cataract surgery.

To examine the visual outcomes and risk factors of uveitis cataract eyes after phacoemulsification and manual small-incision cataract surgery (MSICS). Tertiary-care eye hospital in southern India. Retrospective interventional case series. Of the uveitis eyes operated for cataract surgery between 2017 and 2020, eyes with a minimum of 6 months postoperative follow-up were included. Eyes with ocular trauma, lens subluxation, lens-induced uveitis, or retinal detachment-induced uveitis were excluded. Demography, visual acuity, intraoperative and postoperative records, and surgical outcomes were analyzed. 191 eyes of 191 patients with a mean age of 51.7 ± 14.4 years were included. Phacoemulsification was performed in 134 eyes, and 57 eyes underwent MSICS. Synechiolysis and pupil-expanding maneuvers were required in 74 eyes (38.7%). No differences were noted in the rates of complications between phacoemulsification and MSICS eyes, except at 1 year, where higher rates of posterior capsular opacification and vitritis were noted in MSICS eyes ( P = .018). The visual outcomes of eyes that underwent MSICS and phacoemulsification were comparable ( P = .463). In 12 eyes (13.5%), improvement in vision was not significant. This study shows phacoemulsification may be a preferred technique in uveitis cataracts, given the lesser incidence of postoperative complications. Patients should be counseled for realistic expectations.

EFFICACY AND SAFETY OF MANUAL SMALL-INCISION CATARACT SURGERY WITH TRABECULECTOMY VERSUS PHACOTRABECULECTOMY IN THE TREATMENT OF GLAUCOMA WITH CATARACT: A SYSTEMATIC REVIEW AND META-ANALYSIS

Introduction & Objectives : The coexistence of two globally leading causes of blindness, glaucoma and cataract, is frequent, while the consideration of surgical management is complex. Therefore, a systematic review and meta-analysis was conducted to compare the efficacy and safety of two surgical procedures, manual small-incision cataract surgery (MSICS) combined with trabeculectomy and phacotrabeculectomy.
 Methods : A comprehensive search was performed in PubMed, Science Direct, and Cochrane Library published up to March 2023. Articles not indexed in those databases were also searched. Pooled odds ratios (OR) and mean differences (MD) with corresponding 95% confidence interval (CI) were also retrieved to compare the outcomes estimating efficacy and safety. Biases in selected studies were assessed.
 Results : A total of seven studies consisting of 352 eyes for MSICS with trabeculectomy and 348 eyes for phacotrabeculectomy were included. Postoperative intraocular pressure (IOP) was comparable between the two techniques (MD: -0.45; 95%CI: -1.07 to 0.16; p=0.15). Postoperative Best Corrected Visual Acuity (BCVA) <6/12 (OR: 1.26; 95%CI: 0.62 to 2.53; p=0.52), complete success (OR: 0.92; 95%CI: 0.51 to 1.67; p=0.78), and postoperative complications (OR: 1.27, 95%CI: 0.75 to 2.15, p=0.38) did not differ significantly.
 Conclusion : This meta-analysis indicated no significant difference between MSICS with trabeculectomy and phacotrabeculectomy regarding the efficacy and safety profile. Further high-quality studies are required to confirm these findings.

Comparison of Corneal Endothelial Cell Loss during Manual Small-incision Cataract Surgery using Visco-expression versus Irrigating Wire Vectis-assisted Nucleus Removal: A Prospective Randomised Study

Introduction: Age-related cataract is the leading cause of curable blindness in India, and Manual Small-Incision Cataract Surgery (MSICS) is a machine-independent and cost-effective alternative to phacoemulsification for handling this significant burden. In every cataract surgery, some endothelial cell loss is inevitable. Therefore, the present study was conducted to compare endothelial cell loss in the two most commonly practiced methods of nucleus delivery in MSICS. Aim: To compare and analyse endothelial cell loss during MSICS using viscoelastic/viscoexpression-assisted nucleus removal versus irrigating wire vectis-assisted nucleus removal. Materials and Methods: A prospective randomised interventional study was conducted at the Regional Institute of Ophthalmology, Postgraduate Institute of Medical Sciences (PGIMS) Rohtak, Haryana, India. The study duration was three years, from May 2018 to May 2021. A total of 250 patients with uncomplicated senile cataract over 40 years of age, with nuclear sclerosis of grade 2 or higher and “with the rule” astigmatism, were included in the study. The patients were randomly divided into Group A and Group B (125 each), who underwent MSICS using visco-expression (Group A) versus irrigating wire vectis-assisted (Group B) nucleus removal. Visual Acuity (VA), keratometry, astigmatism, pachymetry, and Endothelial Cell Density (ECD) were recorded in every patient preoperatively and postoperatively on day 1 and day 40. The Shapiro-wilk test was used to assess the normality of the data, and student’s t-test was performed to identify significant differences in continuous factors between the two groups. Chi-square test was used to find the association between factors and techniques, with a p-value <0.05 considered statistically significant. Results: The mean age of the patients was 68.5±9.4 years (range 52-89 years) with a significant male preponderance. The mean LogMAR visual acuity on Postoperative Day (POD)-1 was 0.3±0.1 for Group A, while for Group B, it was 0.5±0.2, showing a statistically significant difference (p=0.004). However, on day 40, visual acuity was comparable in both groups, with Group A (0.1±0.2) and Group B (0.1±0.1), and no significant difference (p=0.09). On POD-1, the percentage change in Endothelial Cell Density (ECD) was 4.2% in Group A and 10.6% in Group B, with a statistically significant difference (p=0.0017). On day 40, it was 2.1% and 4.8% in Group A and Group B, respectively, also showing a statistically significant difference (p=0.003). On postoperative day 40, the mean Surgically Induced Astigmatism (SIA) in Group A and Group B was 0.67±0.24 and 0.74±0.41, respectively, but this difference was statistically insignificant (p=0.074). Intra and postoperative complications such as hyphema, iridodialysis, and corneal oedema were more common in Group B than Group A. Conclusion: The study concludes that there was a statistically significant endothelial cell loss in the irrigating wire vectisassisted nucleus delivery method compared to the viscoexpression of the nucleus during MSICS. The present method also showed delayed visual rehabilitation and a higher risk of intra and postoperative complications. Therefore, viscoexpression of the nucleus should be the preferred method of nucleus delivery in every MSICS where feasible.

Study of Surgical and Visual Results and Complications of Manual SICS in a Tertiary Care Medical College in India

BACKGROUND
 Small-incision cataract surgery (SICS) is a widely practiced surgery in developing nations. Its cost-effective nature and compatibility with high-volume facilities make it a valuable option, offering favorable visual outcomes for most patients. This study was done to evaluate the visual results of SICS procedures performed at a tertiary care center in Urun, Islampur and investigate the factors contributing to suboptimal visual outcomes.
 METHODS
 A total of 200 cataract patients were enrolled in this study. The research encompassed a comprehensive analysis of intraoperative and postoperative complications. There was a comparison made between postoperative visual acuity (VA) and preoperative VA, with a dedicated examination of the determinants of diminished visual outcomes. Follow-up evaluations were carried out on days 1, 3, 7, 14, and 30.
 RESULTS
 The average age of the patient cohort was 63 years, with a slightly higher representation of females (52%) compared to males. The most frequently encountered surgical complication with 5.5% incidence was striate keratopathy, which was then followed by iris damage which had an incidence of 4.5%. The other common complications included posterior capsular rent (PCR) with vitreous loss (3.5%), hypotony (0.10%), intraocular lens decentration (0.50%), surgically induced astigmatism (0.20%) and endophthalmitis (0.50%). Notably, 98% of the patients achieved visual acuity exceeding 6/18. Complications associated with suboptimal visual outcomes (<6/18) were primarily attributed to posterior capsular rent, surgically induced astigmatism, and endophthalmitis.
 CONCLUSIONS
 While SICS may carry a certain risk of complications, the majority of patients can attain favourable visual outcomes.

Efficacy and Safety of Manual Small-Incision Cataract Surgery With Trabeculectomy Versus Phacotrabeculectomy in Patients With Glaucoma and Cataract: A Systematic Review and Meta-Analysis.

The coexistence of two globally leading causes of blindness, glaucoma and cataracts, is common. Combining trabeculectomy with cataract surgery is a common practice while determining the preferred surgical management for patients is a complex consideration. Therefore, a systematic review and meta-analysis were conducted to compare the efficacy and safety of two surgical procedures, manual small-incision cataract surgery (MSICS) combined with trabeculectomy andphacotrabeculectomy. A comprehensive search was performed in PubMed, Science Direct, and Cochrane Library published up to March 2023. Articles not indexed in those databases were also searched. Pooled odds ratios (OR) and mean differences (MD) with corresponding 95% confidence interval (CI) were also retrieved to compare the outcomes estimating efficacy and safety. Biases in selected studies were assessed. A total of seven studies consisting of 352 eyes for MSICS with trabeculectomy and 348 eyes forphacotrabeculectomywere included. Postoperative intraocular pressure (IOP) was comparable between the two techniques (MD: -0.45; 95% CI: -1.07 to 0.16; p = 0.15). Postoperative best corrected visual acuity (BCVA) <6/12 (OR: 1.26; 95% CI: 0.62 to 2.53; p = 0.52), complete success (OR: 0.92; 95% CI: 0.51 to 1.67; p = 0.78), and postoperative complications (OR: 1.27; 95% CI: 0.75 to 2.15, p = 0.38) did not differ significantly. This meta-analysis indicated comparable efficacy and safety profile between MSICS with trabeculectomy andphacotrabeculectomy. Further high-quality studies are required to confirm these findings.

Manual small-incision cataract surgery - A stepping stone toward self-independent cataract surgeons.

Manual small-incision cataract surgery - A stepping stone toward self-independent cataract surgeons.

Flow capsulorhexis: A novel technique in white and hypermature cataracts.

We described a novel "flow capsulorhexis" technique in white and hypermature cataracts and compared it with the standard "needle decompression capsulorhexis" technique. Six hundred and eight eyes of 420 patients with intumescent or non-intumescent mature white cataracts who had undergone phacoemulsification or manual small incision cataract surgery with "flow capsulorhexis" (Group 1) or "needle decompression capsulorhexis" (Group 2) were assessed. The mean continuous curvilinear capsulorhexis (CCC) completion time was 6.6 ± 3.4 seconds in Group 1 and 10.4 ± 4.2 seconds in Group 2 (P < 0.001). The mean number of times for an ophthalmic viscosurgical device (OVD) supplement was 0.4 ± 0.2 and 1.8 ± 0.8 in Group 1 and Group 2, respectively (P < 0.001). CCC success rate was 95.8% in Group 1 and 87.2% in Group 2 (P = 0.001). The new technique was observed to have better outcomes in terms of surgical time, OVD supplement times, and success rate than the standard needle decompression technique.

Clinical assessment of corneal complications of manual small incision cataract surgery at tertiary care centre

: To assess corneal complications and visual outcome of manual small incision cataract surgery.: This study comprises of 227 patients in a tertiary care centre in Kolar district, who underwent MSICS were examined for corneal complications and visual outcome postoperatively on Day 1, 1 week, and at the end of 6 week also visual acuity (VA) assessment, anterior segment evaluation with slit lamp biomicroscopy, posterior segment evaluation using indirect ophthalmoscopy, and keratometry was done.227 participants were included in the study, of whom 138 (61%) were female and 89 (39%) were male. The maximum number of patients being in the age group of 61-70 (42.7%). OCTET grading was done for corneal edema patients and on post op Day 1, total 62 patients who had corneal edema in the study were graded according to OCTET classification, and 6 patients (9.6%) had grade 1, 17 patients (27.4%) had grade 2 and 39 patients (63%) had grade 3. At the end of 6 week postoperatively, 45 patients had clear cornea, and 5 patients (8%) had grade 1, 6 patients (9.5%) had grade 2, and 7 patients (11.1%) had grade 3, and 82.3% of patients had VA of 6/6 to 6/9 followed by 11% had 6/12 to 6/18 and 6.6% had 6/24 to 6/36.: Small incision cataract surgery is most cost-effective surgery if corneal endothelium is protected during surgery and will have early visual rehabilitation.

Epidermal inclusion cyst after uneventful small incision cataract surgery: A diagnostic dilemma

Conjunctival cysts are not so uncommon after surgical procedures. They are usually benign in nature and are filled with serous material and mucous. They may be congenital or acquired in origin. Acquired cysts are mostly seen after ocular surgery and trauma. Hereby, we report two cases of conjunctival inclusion cysts following uneventful manual small incision cataract surgery in two elderly females. Both cases were treated by cyst excision and suturing of the scleral tunnel with interrupted sutures was done. An unstable scleral wound may be a contributory factor in the formation of cysts. Hence, we conclude that closure of the scleral tunnel with overlying tenon and conjunctival apposition is a critical step in controlling such complications of cataract surgery.

Visual Outcomes of Cataract Surgery at the Eye Foundation Community Hospital in Nigeria

Aims: To determine the visual outcome of cataract surgeries postoperatively at first day, one and three months. &#x0D; Study Design: Retrospective, case series study.&#x0D; Place and Duration of Study: Eye Foundation Community Hospital, Ilese-Ijebu-Imushin, Ogun state of Nigeria. 3-month duration from June 1st 2019 to August 31st 2019.&#x0D; Methodology: All patients 18 years and above operated for cataract surgery without comorbidity were included in the study. Type of surgery done were manual small incision cataract surgery (MSICS) and phacoemulsification. Patient data were entered into excel spread sheet created for the study. From where it was cleaned up and exported in to statistical package for social sciences 20. Visual outcome was assessed on the first day, first month and at third month post operatively. Snellen visual acuity was converted to log MAR. P value = 0.05 is determined as statistically significant. &#x0D; Results: Two hundred and fifty (250) patients or eyes were analysed in this study. Two hundred and twenty patients (88%) had MSICS, 30 (12%) had phacoemulsification. Preoperatively, majority (150, 60%) presented with visual acuity less than 3/60 followed by patients with visual acuity between 6/18 to 6/60 (76, 30.4%). Nineteen patients (7.6%) had visual acuity of 6/18 or better. Mean preoperative log MAR was 1.6 ± 0.8 (equivalent to count finger). 3-month post op, two hundred and fourteen (85.6%) had uncorrected visual acuity of 6/18 or better while 231 patients (92.4%) had best corrected (with pinhole) visual acuity of 6/18 or better. (P=0.004 and 0.038 respectively). &#x0D; Conclusion: There is an appreciable improvement in the visual outcome following cataract surgery.

Morphological Changes in the Endothelium of Cornea after Cataract Surgery: A Comparison between Phacoemulsification and Manual Small Incision Cataract Surgery

Background: Endothelial cell loss and corneal decompensation after cataract surgery is well-documented. After endothelial cell loss, the adjacent cells enlarge and slide over to maintain endothelial cell continuity, which is observed as a change in the endothelial cell density and morphology of the cornea. Objective: The study aims to assess and compare morphological changes (i.e., endothelial cell loss) in cornea after phacoemulsification with posterior chamber intraocular lens (PCIOL) implantation and manual small incision cataract surgery (MSICS) with PCIOL implantation. Methods: 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. 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. Results: The mean endothelial cell count was found decreased at day 1 (2585.07±355.65/mm2 vs. 2598.07±385.76/mm2), after 1 week (2564.72±347.23/mm2 vs. 2388.77±326.46/mm2) and after 3 months (2476.72±346.69/mm2 vs. 2248.77±354.47/mm2) following phacoemulsification and MSICS from their preoperative values (2745.35±395.27/mm2 vs. 2673.04±388.28/mm2) respectively. However, no significant difference was observed in mean endothelial cell count of both groups (P&gt;0.05). The mean percentage of endothelial cell loss were observed 5.84±10.02% and 2.80±0.65% at day 1, 6.58±12.15% and 10.63±15.92% at 1 week, 9.78±12.29% and 15.87±8.71% at 3 months after phacoemulsification and MSICS. However, the difference observed in amount of endothelial cell loss between the groups was not statistically significant (P&gt;0.05). Conclusion: To summarize, a decreased endothelial cell count was observed after cataract surgery in both phacoemulsification and MSICS procedures from their preoperative values respectively. However, the difference was not significant between two procedures. Mugda Med Coll J. 2023; 6(1): 11-15

Small incision cataract surgery in rural communities in Uttar Pradesh: A clinical study of postoperative complications and visual outcomes at a tertiary eye hospital

To study the incidence of postoperative complications and visual outcome following manual small incision cataract surgery.This is a hospital-based retrospective study comprised of 1020 eyes of 1020 cataract patients above 31 years without any systemic illness. This study was overseen in a rural tertiary hospital in North India from November 2020 to February 2021. All patients were analyzed according to their history, age, sex and a thorough clinical examination was done. Manual small incision cataract surgery was done for all patients, and they were examined on the first postoperative day and after 1 month.In our study 57% of patients are male and 43% are female. The maximum number of patients were in the age group of 61–70 years. Intraoperative complications PC rent noticed in 1 case zonular dehiscence in 2 patients, and 3 patients were left aphakic. On the first post-op day, Striate keratopathy was 2%, Residual cortex 3%, FM Threads 9%, Anterior uveitis cells 3%, Blood clots &amp; Dispersive hyphema 3%, Epithelial defects 1%, Corneal edema 4% were seen. Post-operative uncorrected vision at day one 83% of cases achieved good visual acuity (≥ 6/18) and the rest 16% were borderline acuity (&amp;#60;6/18-6/60), which at 1-month post-operative day good visual acuity improved to 87% of cases. Small incision cataract surgery (SICS) with Posterior chamber intraocular lens (PCIOL) is an approved method of community-premised cataract surgery to overcome the large cataract reserve in our country it gives consistently good visual acuity post-operatively and negligible complications.