PC IOL Implantation Research Articles

Corneal Endothelial Changes Following Anterior Chamber Intraocular Lens Implantation in Extracapsular Cataract Surgery

Aim: To determine & quantify corneal endothelial changes after primary or secondary implantation of anterior chamber intraocular lenses (AC IOLs) in extracapsular cataract surgery complicated by loss of capsule support. Setting: Ibn Al- Heythem teaching eye hospital, Baghdad. Patients & Methods: This prospective study comprised 125 patients underwent extracapsular cataract surgery complicated by loss of capsular support. Of them 76 patients had primary implantation of open-loop AC IOLs. The other 49 patients were kept aphakic after similar complicated cataract surgery & had secondary AC IOL implantation (open-loop), this was performed 10 weeks to 2 years from initial cataract surgery. At least 2 weeks post AC IOL implantation, non-contact specular microscopy was performed at the center of the cornea for eyes with primary & secondary AC IOLs implantation, their fellow eyes (phakic or pseudophakic with posterior chamber PC IOL) taken as control. Results: The mean endothelial cell density (ECD) was significantly lower in eyes with primary or secondary AC IOL implantation than in unoperated phakic eyes. Patients with primary AC IOL implantation in 1 eye & PC IOL implantation in fellow eye had a difference in ECD that was not statistically significant. The ECD difference was significantly greater in eyes with secondary AC IOL implantation compared to fellow pseudophakic eyes (PC IOL). The coefficient of variation (CV) in cell size & percentages of hexagonality showed no significant changes in the various groups. Conclusion: AC IOL implantation didn't appear to alter corneal endothelial function. Results indicate that endothelial cell loss was related to surgical trauma rather than the presence of AC IOL.

ASSESSMENT OF VISUAL ACUITY AND COMPLICATIONS POST CATARACT SURGERY IN PATIENTS WITH UVEITIS IN TERTIARY CARE HOSPITAL

Aim and Objectives Aim:To study the visual acuity and operative complications after cataract surgery in patients with uveitis in tertiary care hospital Objectives: 1.To study factors affecting visual acuity. 2.To study surgical complications post cataract surgery in uveitis patients. Materials and Methods:A total of 18 patients were taken, data was collected from all the selected patients using a structured proforma meeting the objectives of the study. • Inclusion Criteria:1.All complicated cataract patients attending ophthalmology OPD 2.A quite eye (without inflammation) for atleast 3 months • Exclusion Criteria: 1.Cataract due to causes other than uveitis 2.Patients with posterior segment pathology Patients were scheduled for follow up on post op day 1, day 3 , day 7 , day 15, day 30, day 60, day 90. Results: The prevalance was more common in males compared to females. Out of 18 patients, 14 (77%) underwent SICS with PCIOL implantation and 4 (22%) underwent phacoemulsification with PCIOL. Intra-operative complications were noted as small non-dilating pupil, peripheral anterior synechiae, pupillary membrane, incomplete capsulorhexis, iris prolapse. In 7 (38%) patients sphincterectomy was done and in 4 (22%) patients stretch pupilloplasty was done. Immediate post-op complications that were noted were anterior chamber reaction and pigment dispersion. Late post-op complications that were noted were posterior capsular opacification Dense posterior synechiae were encountered in 12 (66%) patients and excessive conjunctival bleeding in 6(33%) patients. There was improvement in visual outcomes as follows 8 patients had 6/6 vision, 6 patients had 6/18 vision where as remaining 4 patients had 6/36 vision due to early development of posterior capsular opacification. Conclusion: Cataract development is a very common occurrence in any form of anterior and intermediate uveitis because of chronic intraocular inflammation, long term use of corticosteroids. Reported incidence of cataract in uveitic patients is about 25% in juvenile rheumatoid arthritis and 75% in chronic anterior uveitis. It is possible to achieve successful visual outcomes following cataract surgery in uveitis by proper management of pre-operative inflammation and close post-operative observation. Management of uveitic cataract requires careful case selection, proper timing of surgery, and close monitoring with appropriate handling of complications that may occur.

Nanophthalmos with angle closure glaucoma, a challenging case

Link of Video Abstract: https://youtu.be/eGhTbOkaaQI Introduction: Nanophthalmos basically is a simple microphthalmos with clinical characteristics of short axial length (AL), shallow anterior chamber (AC), high lens to eye volume ratio, small cornea and thick sclera, associated with angle closure glaucoma. We report a case of nanophthalmos with angle closure glaucoma and cataract who underwent trabeculectomy and end up with malignant glaucoma. Pars plana vitrectomy (PPV) and phacoemulsification with posterior chamber intraocular lens (PC IOL) implantation was done to manage the case. Case Description: A 41-year-old man came with blurred vision in the right eye with redness and headache for 8 weeks. Intraocular pressure (IOP) was 46 mmHg, visual acuity was counting fingers at 2 m with nystagmus. Slit lamp examination revealed short axial length (AL), shallow anterior chamber (AC), small corneal diameter and high lens to eye volume. Trabeculectomy with 5FU was done with complication of malignant glaucoma. After PPV combined with phacoemulsification and PC IOL implantation, IOP was 14 mmHg, visual acuity 0.125 with deep AC. Conclusion: Surgical intervention in nanophthalmos with angle closure glaucoma must be managed with good preparation. Malignant glaucoma in this case can be managed with pars plana vitrectomy and phacoemulsification without scleral procedure.

In bag IOL implantation with Cionni ring: A case report

The supertemporal subluxation of the lens due to zonular weakness is one of the hallmarks of ocular signs with Marfan's syndrome. Cionni capsular tension ring (CTR) implantation can help to overcome this issue and correct the capsular bag decentration. We describe the visual outcome, intra and post-surgical findings of phacoemulsification with Cionni capsular tension ring and PCIOL implantation in a case of an 18-year-old-boy presented with the features of a typical Marfan’s syndrome.

STUDY OF OUTCOMES IN PATIENTS OF CHRONIC SIMPLE GLAUCOMA UNDERGOING SMALL INCISION CATARACT SURGERY WITH TRABECULECTOMY

Aim:To study outcomes of procedure ( Small incision cataract surgery with PCIOL implantation with trabeculectomy) in terms of visual acuity , intraocular pressure and complications. Methodology: A hospital based descriptive longitudinal study was done on 22 patients with chronic simple glaucoma operated at Pravara rural hospital ,Loni. The pre-operative and post operative data was collected in terms of Visual Acuity recorded with Snellens chart and Intra Ocular pressure recorded with help of Applanation Tonometer or Non Contact Tonometer in uncooperative patients. The Trabeculectomy and SICS with PCIOL were performed at separates site.The preoperative mean IOP was 28 mmHg with good functional visual acuity ranging from Finger counting 4 meters to 6/24 with coexisting cataract. The IOP and VA were noted post operative 1 Week and 6 weeks. Results: Mean age of the patients in the study was 74 , 5 ( 22.7 %) were less than and equal to 60 years , 8 ( 36.3 % ) were between 61 and 70 years , 7 ( 31.8 % ) were between 71 and 80 years , 2 ( 9.1 %) were above 80 years .Out 0f 22 patients , 16 (72.7%) were male and 6 ( 27.3) were female .Mean intraocular pressure on post operative 1 week and 6 weeks was 17.3 mmHg and 17 mmHg respectively . Significant visual improvement was seen in patients who underwent combine surgery .Postoperative BCVA at 6 weeks below 6 / 60 in 3 patients (13.6 %) , between 6 /60 to 6/24 in 9 ( 40 .9 %) , above 6 /24 in 10 patients (45.5 %). Conclusion: Management of coexisting cataract with chronic simple glaucoma in one setting has advantage of no financial burden as financial burden is main cause of non compliance in the poor rural population.

Comparative evaluation of “in-the-bag” intraocular lens implantation with cionni ring versus pars plana lensectomy–vitrectomy with anterior chamber IOL implantation in subluxated lenses in pediatric eyes

Background: Subluxation of the crystalline lens has various surgical management options. In moderate zonular dialysis, the capsular bag may be preserved and used for intraocular lens (IOL) implantation using a capsular tension ring or Cionni ring or Capsular tension segment. It is technically demanding and associated with high incidence of complications such as IOL decentration, dislocation, and posterior capsular opacification (PCO). Advantages of the combined pars plana lensectomy–vitrectomy (PPL/PPV) with anterior chamber IOL (ACIOL) approach include a closed ocular surgical system, minimal corneal trauma, limited iris trauma, and good vitreous control. Therefore, in this study, we aim to study the outcomes of inthe-bag IOL implantation with Cionni ring versus PPL/PPV with ACIOL in subluxated lenses in children. Aims and Objectives: The aims of this study were to compare “in-the-bag” IOL implantation with Cionni ring versus PPL/PPV with ACIOL implantation in subluxated lenses in children. Materials and Methods: In this prospective, comparative, and interventional case series, 20 eyes (18 children, 8–18 years) with 90–210° subluxation were randomly allocated into two groups (ten eyes each). Group A underwent single eyelet Cionni Ring with in-the-bag PCIOL implantation and Group B underwent PPL/PPV with ACIOL. Outcome measures included best-corrected visual acuity (BCVA), endothelial cell count (ECC), intraocular pressure, fundus evaluation, and intraoperative/post-operative complications. Results: The etiology of subluxation included trauma (40%), Marfan’s syndrome (20%), myopia (20%), and others (20%). In Group A, intraoperative difficulties were encountered in capsulorrhexis, irrigationaspiration, and increased duration of surgery. Two eyes in Group B had intraoperative lens fragment drop in vitreous. At 3 months, no statistically significant difference in BCVA was noted. About 90% eyes in Group A and 80% eyes in Group B had final BCVA of ≥6/18. ECC and PCO were significantly higher in Group A at 3 months. Conclusion: Implantation of planned open-loop ACIOL is viable surgical alternative to Cionni ring with PCIOL implantation in large lens subluxation and good pre-operative ECC.

Management and visual outcome in patients of phacolytic glaucoma at a tertiary eye care hospital

Phacolytic glaucoma is one of the commonest cause of secondary glaucoma due to senile cataracts. This study was conducted to evaluate the visual outcome of phacolytic glaucoma. 1. To study the management of phacolytic glaucoma; 2. To study the visual outcome after planned manual SICS. Participants were 30 patients in a tertiary eye care hospital for both urban and rural population diagnosed as phacolytic glaucoma. Demographic data, duration of the symptoms, IOP of the patients before presenting to the hospital were noted. Patient underwent Manual SICS with PCIOL implantation after the control of intraocular pressure and inflammation. The data was analyzed by simple statistical methods. Mean age of the patients was 61.63 yrs. Female to male ratio was 1.8:1. Duration of the presenting symptoms before reporting to the hospital was <1 week in 16 (53%), 1-2 week in 11 (37%) and >2 week in 3 (10%). Mean IOP was 40.7mmHg preoperatively. Visual Acuity was perception of light in 16 (53.33%) and hand movements in 14 (46.66%) preoperatively. Postoperative visual acuity at 6 weeks was 6/6-6/12 in 19(63.33),6/18-6/60 in 8 (27%), <6/60 in 3 (10). Following surgery 28 of 30 eyes (93.33%) had IOP less than 21 mmHg at discharge. Fellow eye showed pseudophakia in 18 (60%), immature cataract in 12 (40%). Cataract surgery proves to be effective in lowering the intraocular pressure and visual recovery in phacolytic glaucoma.

Early lens aspiration with posterior chamber intraocular lens and capsular tension ring in microspherophakia to avoid lens-induced complications.

PURPOSE:To report the surgical outcome of early lens aspiration, posterior chamber intraocular lens (PC IOL), and capsular tension ring (CTR) in a case series of microspherophakia (MSP) and secondary glaucoma.METHODS:Case series of 18 eyes of MSP cases presented with lenticular myopia and secondary glaucoma that underwent early lens aspiration, PC IOL and CTR by one ophthalmologist. Baseline, long-term postoperative outcomes and complications were documented.RESULTS:All cases underwent successful surgery with lens aspiration PC IOL implantation and CTR insertion without intraoperative complications. One of the 18 cases was a delayed referral which had broad anterior synechiae and following lens aspiration developed corneal decompensation. In one eye, CTR implantation was not possible hence, lens aspiration with scleral fixation (SF) of 3 piece IOL was performed (excluded from the analysis). Overall there was an improvement in visual acuity (from 0.3 ± 0.1 to 0.2 ± 0.2 LogMar, P = 0.006), intraocular pressure (IOP), and most notably, deepening of the anterior chamber. Some cases required subsequent glaucoma surgery to control IOP. After a long duration of follow-up, all cases had stable capsular lens complex and no capsular phimosis.CONCLUSION:Early Lens aspiration with CTR and PCIOL alone in MSP with lens subluxation has a significant impact on the patient's quality of vision, deepening the anterior chamber and preventing complications or poor outcomes. In addition, good capsular-lens complex stability and absence of capsular phimosis or phacodonesis on long-term follow-up were obtained.

A comparative study of post-operative astigmatism in superior versus superotemporal scleral incisions in manual small incision cataract surgery in a tertiary care hospital

Background: In developing countries, manual small incision cataract surgery is a better alternative and less expensive in comparison to phacoemulsification and thus the incision is an important factor causing high rates of postoperative astigmatism resulting into poor visual outcome. Thus, modifications to the site of the incision is needed to reduce the pre-existing astigmatism and also to prevent postoperative astigmatism. Modification to superotemporal incision relieves pre-existing astigmatism majorly due to its characteristic of neutralizing against-the-rule astigmatism, which is more prevalent among elderly population and thus improves the visual outcome. Aims: To study the incidence, amount and type of surgically induced astigmatism in superior and superotemporal scleral incision in manual SICS. Methodology: It is a randomized, comparative clinical study done on 100 patients attending the OPD of Ophthalmology at a tertiary care hospital, with senile cataract within a period of one year and underwent manual SICS. 50 of them chosen randomly for superior incision and rest 50 with superotemporal incision. MSICS with PCIOL implantation were performed through unsutured 6.5 mm scleral incision in all. Patients were examined post-operatively on 1st day, 7th day, 2nd week and 4th week and astigmatism was evaluated and compared in both groups. Results: It is seen that on postoperative follow up on 4th week, 77.78% of the patients with ATR astigmatism who underwent superior incision had increased astigmatism whereas, only 13.63% of the patients with ATR astigmatism who underwent supero-temporal incision, had increased astigmatism but 81.82% had decreased ATR astigmatism. However, 77.78% of the patients with preoperative WTR astigmatism who underwent supero-temporal incision, had increased astigmatism, whereas 44.45% of the patients with WTR astigmatism preoperatively, had increased astigmatism in contrast to 50% had decreased amount of astigmatism. It is also seen that the supero-temporal incision group had more number of patients (78%) with visual acuity better than 6/9 at 4th postoperative week than superior incision group (42%). Conclusion: This study concludes that superior incision cause more ATR astigmatism postoperatively whereas superotemporal incision causes lower magnitude of WTR astigmatism, which is advantageous for the elderly. Besides superotemporal incision provides better and early visual acuity postoperatively.

A Comparative Evaluation of Macular Thickness after Phacoemulsification and Manual SICS in Diabetic Patients by Optical Coherence Tomography

Background: The main aim of the study is to compare the change in macular thickness after uncomplicated phacoemulsification versus uncomplicated manual SICS in known diabetic patients by optical coherence tomography Methods: This study was an observational study involving 50 patients with each group having 25 patients. Group 1 was operated with Phacoemulsification through limbal 2.8 mm incision with Foldable PCIOL implantation. & Manual small incision cataract surgery through 5.5 to 6.5 mm incision with sclerocorneal tunnel with PMMA PCIOL implantation. For all patients, macular OCT was performed during preoperative period & post-op 1st day,7th day, 1st month, 3rd month & 6th month. Statistical software SPSS, version 21.0 was used for statistical analysis. Results: In both PHACO & SICS group MCFT rose steadily during post-operative period and SICS group shows high rise during follow up.The MCFT shows a difference between PHACO & SICS group with the highest MCFT observed in 1st month follow up i.e., 231.6 micrometer (SD ±7.831) in PHACO group & 241.64 (SD ±7.35) micrometer in SICS group. The MCFT returned to near pre-op value by the 6th month. Conclusion: There is no effect of age and sex on macular thickness before and after in both PHACO and SICS groups. In SICS group significant macular thickness was observed as compared to PHACO group, so there should be more cautious to undertake SICS in those patients who are at risk of developing macular edema or who have a higher macular thickness as seen in diabetes patients. Keywords: Phacoemulsification (PHACO), small incision cataract surgery (SICS), Cystoid macular edema.

A CLINICAL STUDY ON LENS INDUCED GLAUCOMA IN PATIENTS ATTENDING GOVERNMENT GENERAL HOSPITAL,SRIKAKULAM.

AIM: To determine the prevalence and visual outcomes after cataract surgery in different LIG patients METHODS:In this prospective study 50 patients were taken into study. Detailed history was taken and slit lamp examination was done & IOP was recorded by AT. All the patients were treated preoperatively appropriately. Patients were operated with SICS with PC IOL implantation and Peripheral Iridectomy.During follow up a detailed Ocular examination was done including Refraction using snellens chart and IOP measurement with AT. RESULTS: Among 50 patients 21(42%)were male patients and 29(58%)were female. Maximum patients had Phacomorphic Glaucoma accounting 72% (36patients) and Phacolytic Glaucoma 24%. Highest percentage was among 40-49mmHg (52%) followed by 30-39mmHg (36%) and >50mmHg (10%). Highest patients were between 10-19mmHg (76%). Visual acuity on admission, highest patients were seen in HM positive (64%) followed by PL+(32%). Even No PL were also seen (4%). On follow up after 6weeks ,majority were seen between 6/12- 6/18(52%) CONCLUSION: LIG is an important vision-threatening disease presenting as a painful red eye. It is remaining as one of the important cause of Blindness not only because of Senile cataract but even after cataract surgery due to Glaucoma caused by neglected cataractous lens.Hence, importance should be given for timely surgery for better visual outcome .

Nepafenac vs bromfenac: A comparative study to determine their role in maintaining mydriasis during cataract surgery

To assess and compare the role of topical nepafenac (0.1%) v/s bromfenac (0.09%) in sustaining intra-operative mydriasis while doing cataract extraction.: Prospective, randomized study. Regional Institute of Ophthalmology, Rajendra Institute of Medical Sciences (RIMS), Ranchi (Jharkhand). The duration of study was from June 2019 to February 2020. Topical NSAIDs (nepafenac and bromfenac) and carboxymethylcellulose (control) were administered to the cataract patients before Phaco surgery. Pupillary diameters were assessed first at starting of surgery and then after completing the surgery; average values were calculated for the three groups. Study was done on 90 patients having age 40-80 years, planned for cataract surgery with PCIOL implantation. : in group A (i.e. control) reduction in pupillary diameter came out to be more statistically significant unlike in group B (nepafenac) and in group C (bromfenac) (p <0.003). But on comparing group B and group C(p < 0.80) reduction in pupillary diameter was not that much statistically different. Mydriasis sustaining effect was more pronounced in groups B and C than in group A. : Both nepafenac (0.1%) and bromfenac (0.09%) administered a day before operation are helpful in sustaining pupil size intra-operatively but bromfenac comparatively seemed to be better than nepafenac in sustaining mydriasis during SICS/Phaco.

Comparative study of endothelial cell loss in trabeculectomy with combined small incision cataract surgery (SICS), trabeculectomy procedure and temporal small incision cataract surgery (SICS) alone

When a patient suffers from co-existing cataract and glaucoma, the choice of surgery may be a combined procedure of cataract extraction and trabeculectomy as a one-stage procedure, or trabeculectomy first to restore visual rehabilitation and to prevent progressive optic nerve damage. The main purpose of this study was to evaluate the endothelial cell loss in trabeculectomy with small incision cataract surgery (SICS) against trabeculectomy and SICS alone. Materials and Methods: This study was conducted on 90 eyes divided into 3 groups among whom 30 cases underwent trabeculectomy through a superior incision, 30 cases underwent SICS with PC-IOL implantation with trabeculectomy through a common superior incision and 30 patients underwent manual SICS with PCIOL. The corneal endothelial cell count and loss was assessed on first postoperative day, 1st week, 1st month and at 3 months. IOP was assessed on postoperative 1st week, 1st month and at 3 months. Results: The endothelial cell loss was more in combined SICS with trabeculectomy group than trabeculectomy group alone. Conclusion: Preoperative evaluation of endothelial cell count must be considered and adequate intra-operative and postoperative measures should be taken to avoid cell loss. However, to avoid further endothelial cell loss due to a two staged surgery, a combined procedure would be a better choice. Combined SICS with trabeculectomy would also reduce the economical burden, postoperative morbidity and the visits of patient to operation theatre. Keywords: Cataract, Endothelial cell loss, Glaucoma, SICS, Trabeculectomy.

The effect of manual small incision cataract surgery on the intraocular pressure – A prospective study in south Kerala

Aim: To study the effect of manual small incision cataract surgery (SICS) on the intraocular pressure (IOP) postoperatively at one week, three weeks and three months. Materials and Methods: Prospective longitudinal study, conducted at Dr SMCSI College from January 2016 –May 2017. Sample size: 50 eyes. Patients who underwent uneventful SICS were included. Patients with pre-existing glaucoma, were excluded. Goldman applanation tonometer was used to measure IOP. Preoperative IOP was measured. All patients underwent manual SICS with PCIOL implantation by one surgeon. Postoperative IOP measurements were taken at one week, three week, and three month postoperatively. Analysis done using SPSS 16.0. Results: The mean preoperative IOP was 15.16(SD +/- 2.566) mm Hg. The mean one week postoperative IOP was 14.08 (SD +/- 2.320) mm Hg. The mean postoperative IOP at three weeks was 13.68 (SD +/- 2.343) mm Hg. The mean postoperative IOP at three month was 13.12 (SD +/- 2.496) mm Hg. Paired sample t-test showed p Conclusion: There was significant reduction in intraocular pressure after manual SICS. Keywords: Cataract, Glaucoma, Intra ocular pressure, Small incision cataract surgery.

Endothelial keratoplasty with anterior chamber intraocular lens versus secondary posterior chamber intraocular lens

AimTo describe the long-term outcomes of Descemet stripping automated endothelial keratoplasty (DSAEK) with an anterior chamber intraocular lens (ACIOL) compared to secondary posterior chamber (PC) IOL.MethodsThis was a retrospective comparative...

Comparative study of safety and efficacy of dispersive versus cohesive ophthalmic viscosurgical devices in cataract surgery after phacoemulsification

Background: To compare efficacy and safety of dispersive versus cohesive ophthalmic viscosurgical devices in cataract surgery after phacoemulsification to prevent endothelial cell loss. Material and Method: Total 40 consecutive patients of senile cataract with hard nucleus (grade 3/4) who attended AVBRH eye Opd were selected. 40 cases were randomly divided in two groups depending on the use of two different OVD's as – Group 1 Dispersive (20 cases): Hydroxypropyl methylcellulose (2 %), Group 2 Cohesive (20 cases): Sodium hyaluronate (1.4%). Preoperative examination and evaluation of BCVA, corneal thickness by pachymetry and endothelial cell count by specular microscope was done. ECCE with PCIOL implantation by phacoemulsification was performed by a single surgeon. Postoperative all the parameters were recorded on day 1, 1 week, 1 month and 3 months using the same methods and instruments. Results: In our study there was no significant change was seen preoperatively in age, visual acuity, intraocular pressure, and endothelial cell count among the two groups. Postoperatively rise in IOP was seen in both groups i.e. 30 % in group A and 10 % in group B, corneal endothelial cell loss was seen in both groups after performing phacoemulsification, there was no significant difference in the change in cornea thickness in eyes among two groups (P=0.20). Conclusion: Our study shows no significant difference in endothelial cell count and corneal thickness in eyes between two groups.

CATARACT & OTHER CO MORBIDITIES – STUDY FROM NORTH INDIA.

Background: Rural areas are away from medical facilities & these areas catters more than 3/4th of Indian populations. Thus, eye care services need to be planned & executed in these areas.
 Aim: To determine the prevalence of other ocular and systemic co-morbidities among the camp selected cataract patients in rural areas.
 Methodology: The present observational study was conducted at postgraduate department of Ophthalmology of GMC Jammu & involved patients from various eye camps selected for ECCE (SICS with PC-IOL implantation surgery). Total of 84 patients were participated in the study. Detailed history was taken from the patient & relevant ocular & systemic examination was done.Routine investigations were also done.
 Results: The most frequently occuring systemic co-morbidities was hypertension i.e.36.9% followed by back pain in 32.1% in the present study. The ocular co-morbities other than cataract were diabetic retinopathy in 4.8%, glaucoma in 3.6% etc. Among other ocular co morbidity, optic atrophy, amblyopia, chorioretinal atrophy, macular scar etc were noted.
 Conclusion: From present study it has been concluded that large number of patients who came to seek ocular treatment in eye camps has systemic co morbidities also. Thus, other specialities should also be part of team of eye camp so that along with eye other comorbidities should also be treated.
 Key words: Cataract, Ocular co-morbidities, Systemic co-morbidities.

A 50-year-old woman presented with severe reduction of vision and recurrent pain in right eye following cataract surgery

This article has no abstract. The first 100 words appear below: A 50-year-old female, hailing from Patuakhali, was admitted at the Department of Ophthalmology for the management of severe reduction of vision and pain at the right eye for the last 7 months following cataract surgery at a government hospital. Her cataract surgery (small incision cataract surgery with PC-IOL implantation) of the right eye was performed on October 28, 2018. On the first post-operative day, she developed pain, redness and severe reduction of vision in the right eye. The following day, she was discharged with the advice of some medications like moxifloxacin, dexamethasone, bromfenac eye drops and oral acetazolamide and potassium.

Comparison of Nonphaco small incision Cataract Surgery with Conventional Method: An Observational Study

Background: Cataract surgery is very important for the correction of visual acuity among the patients.
 Objective: The purpose of the present study was to assess the uncorrected visual acuity in small incision cataract surgery (SICS) with PCIOL than conventional method of ECCE with PCIOL implantation.
 Methodology: This cross-sectional study was conducted at National Institute of Ophthalmology, Dhaka, Bangladesh from January 1999 to December 2000 for a period of two (02) years. Patients with senile cataract were selected for study. A comparative study of changes in postoperative visual outcome and refractive status during post-operative follow up period up to 2 months were observed and documented between two groups of patients, one with suture less nonphaco SICS with PCIOL another with conventional ECCE with PCIOL. All the cataract surgery were done by the same surgeon, and in same place. All the patients were examined carefully both pre and post-operatively. For the purpose of recording, a proforma was made that includes particulars of the patient, complete history, general examination, ocular examination, relevant investigations, operation note, perioperative complications, post-operative follow-up, pre and post-operative visual acuity with keratometric reading.
 Result: A total of 60 eyes of cataract patients were included in the study of which 30 eyes of cataract patients were randomly selected for suture less nonphaco SICS with PCIOL and 30 eyes of cataract patients were for conventional ECCE with PCIOL.Mean age distribution (58.83±5.55 and 58.77±6.56) was similar in both groups. The unaided vision in both SICS & ECCE group at different postoperative intervals was reported. At day7 and month 1 postoperatively the result appears highly significant between the two groups. At day 1 and month 2 also shows the significant result between the 2 groups. The best corrected visual acuity in SICS and ECCE group at different postoperative intervals was measured. At day 7 and month 1 postoperatively the result appears highly significant between the two groups. At day 1 and month 2 also shows the significant result between the 2 groups.In SICS group out of 30 patients, 7(23.3%) cases acquired unaided vision 6/9 at day 1, 10(33.3%) patients at day 7,14(46.6%)patients at month 1 and 15(49.9%) patients at month 2. On the other hand in ECCE group no patient was found with vision ≥6/9 at day 1 and only one patient with vision ≥6/9 at day 7.At month 1 there were 5(16.6%) patients, and at month 2 there were 9(29.9%)patients with vision ≥6/9. Nearly 50.0% patients of SICS group achieve unaided vision of ≥6/9 within the follow up period of 02 months.
 Conclusion: In conclusion Uncorrected visual acuity in SICS cases were better than that of ECCE cases with sutures.
 Journal of National Institute of Neurosciences Bangladesh, 2019;5(2): 185-190

Comparative study of surgically induced astigmatism: superior versus superotemporal scleral incision performed in rural hospital

Introduction: Phacoemulsification has become a gold standard procedure of cataract extraction in the developed countries. Phacoemulsification is expensive hence manual small incision cataract surgery is a better alternative in developing nations. One of the important cause of poor uncorrected visual activity after cataract extraction is high astigmatism. Incision being the first and most important determinant of postoperative astigmatism. Placement of incision superotemporally is one modification to minimize the high pre-existing ATR astigmatism and improving the postoperative visual outcome. Aim: To study the type and amount of surgically induced astigmatism following superior and superotemporal scleral incision in manual small incision cataract surgery. Design: Prospective randomized comparative clinical study. Methodology: 50 eyes of 50 patients each were randomly assigned for superior scleral incision and superotemporal scleral incision and MSICS with PCIOL implantation were performed. Patients were examined on day 1, day 7, end of 4 weeks and 3 months after surgery. Results: 3 months after surgery, 80% of the patients in superior incision group had ATR astigmatism and 86% of the patients in super temporal incision group had WTR astigmatism. The mean SIA in superotemporal group was significantly less than superior incision group. Conclusion: MSICS performed with superotemporal scleral incision in comparison with superior scleral incision produces significantly less surgically induces astigmatism with better stabilization of refraction.