Posterior Capsule Rupture Research Articles

Outcomes of cataract surgery in patients previously treated with orbital radiotherapy.

To quantify the risks for cataract surgery in patients who have previously undergone external beam radiotherapy (EBRT). Tertiary ophthalmology and oncology hospital. Retrospective case series. Patients treated with orbital EBRT at the Beatson West of Scotland Cancer Centre between 2001 and 2019 were identified, and clinical records were reviewed to identify those who had subsequently undergone cataract surgery. Preoperative and postoperative case records, and operation records, were reviewed to identify demographic data and data regarding complications and surgical outcomes. 46 eyes (of 33 patients) were included. The indications for EBRT included thyroid eye disease, lymphoma, choroidal metastases, and other orbital malignancies. Mean corrected preoperative Snellen visual acuity was 20/100 (range 20/30 to 20/2000) improving to 20/25 (20/12 to 20/160, 1-way analysis of variance P < .01). Mean visual gain was 0.5 logMAR (-0.9 to 1.9). There was 1 case of posterior capsule (PC) rupture with vitreous loss (2%). Dense PC plaque was noted intraoperatively in 19.5% (n = 9). 13% (n = 6) required Nd:YAG laser posterior capsulotomy. There were 6 cases (13%) of cystoid macular edema (CME). Visual outcomes after cataract surgery in this cohort of patients were similar to those obtained in a nationwide cohort. EBRT seemed to be associated with an increased incidence of intraoperative PC plaque, postoperative CME (which in most cases settled with treatment), and need for posterior capsulotomy.

Posterior Capsule Rupture: Incidence Rate, Associated Characteristics and Visual Outcomes

Purpose: To see the Incidence rate, Risk factors, Associations, and Visual outcomes of posterior capsule rupture (PCR). Methods: A cross sectional study was done of all patients with PCR from June to November 2021 in a Tertiary eye care Hospital. In this study, distribution of the respondents by age, the morphology of cataract, risk factors for PCR, Surgeon’s experience, percentage of Phaco and SICS, in which steps of surgery PCR occurred, implantation of IOL following PCR were analyzed. The final visual outcome of cases with PCR was measured. Results: Among 7650 patients, who underwent cataract surgery during the study period, 142 had eventful cataract surgery with various per operative complications, and PCR was the most common (n = 94). Most of the study population was in the age group 61-70 years (37.2%). About 45% were male, and 55% were female. Among 94 cases, PCR occurred in 65 patients (69.1%) during Phaco and 29 (30.8%) cases during SICS. There was no statistically significant difference between Phaco and SICS for PCR (&gt; 0.05). In most patients (26.1%), PCR occurred during cataract surgeries irrigation and aspiration step. The most common risk factors for developing PCR were small pupil (10.6%) and corneal opacity (9.5%). PCR was higher by trainee surgeons rather than by senior surgeons. There was a statistically significant improvement in postoperative visual acuity even when PCR occurred during surgery (P&lt; 0.001). Conclusions: PCR occurs in all cataract surgeries and is the main intraoperative complication. This study identified the incidence rate and risk factors of occurring PCR during cataract surgery in a tertiary eye hospital of Bangladesh, which may assist in the application of preventive measures to decrease rates of PCR. Eyes having posterior capsule rupture at the time of cataract surgery have a significant risk of reduced visual acuity.

Repair of penetrating ocular trauma with anterior and posterior pole involvement

Context: Ocular trauma is the leading cause of monocular visual impairment around the world, especially in developing countries like Mexico. Great part of this cases occurs in pediatric and young adult groups. Epidemiology can vary depending on the population studied, but different factors such as socioeconomic status, occupation, sport and other activities have a great influence. Approximately 30% to 40% of ocular blindness cases in the world is due to ocular trauma, and of these, between 80 and 90% of events are preventable.1,2 Objective: The aim of this paper is to expose the importance of an individualized and damage-oriented repair plan in the scenario of a penetrating ocular trauma and serve as a treatment guideline in similar cases. Method: A case report of a 15 year-old male with right eye open globe injury with metal cable tip causing a penetrating corneal injury, posterior capsule rupture, lens opacity and vitreous hemorrhage Conclusion: The present case report illustrates the diverse ways of presentation that can be found when managing a penetrating ocular trauma. Our patient history is a good example of extended ocular involvement including cornea, lens, vitreous and retina. Individualized and damaged oriented surgical treatment is key in ocular trauma scenarios.

Previous intravitreal injection as a risk factor of posterior capsule rupture in cataract surgery: a systematic review and meta-analysis.

Intravitreal injections and cataract surgery are two common procedures in the elderly. Posterior capsular rupture (PCR) is a rare but important complication of cataract surgery. We systematically reviewed the literature on previous intravitreal injections as a risk factor of PCR and performed meta-analyses to provide pooled summary risk estimates. We searched 13 literature databases on 1 June 2021 for studies evaluating the risk of PCR in eyes undergoing cataract surgery with data on previous intravitreal injections. Data extraction was made independently by two authors and discussed afterwards until reaching consensus. Random effects meta-analyses on the pooled odds ratio (OR) of PCR in eyes with previous intravitreal injections were made using MetaXL 5.3. Six studies on 1 051 097 eyes undergoing cataract surgery were eligible for the qualitative and quantitative review. Previous history of intravitreal injections was present in 7034 eyes (majority was anti-VEGF). Our meta-analyses revealed that any previous intravitreal injection was a risk factor for PCR with an OR of 2.30 (95% CI 1.39-3.81). For each previous intravitreal injection, the risk of PCR was OR 1.04 (95% CI 1.01-1.08) (equivalent of relative risk ~1.04). In other words, risk of PCR increases by 4% for each previous intravitreal injection. Previous intravitreal injection is a risk factor for PCR and should be taken into account when planning cataract surgery. However, to be regarded as a clinically significant risk of PCR, a substantial number of previous intravitreal injection (e.g. ≥10) should have been administered, considering that the a priori risk of PCR is very low (~1%).

Changing operating room practices: the effect on postoperative endophthalmitis rates following cataract surgery

PurposeTo determine whether four new operating room (OR) protocols instituted because of COVID-19 reduced the cataract surgical postoperative endophthalmitis rate (POE).DesignRetrospective, sequential, clinical registry study.Methods85 552 sequential patients undergoing cataract...

POSA291 Impact of Intrepid® Hybrid Tip on Incidence and Cost of Posterior Capsule Ruptures in Cataract Surgery

The Intrepid® Hybrid tip has a rounded polymer edge designed to decrease the risk of posterior capsule ruptures (PCRs) during cataract surgery. The purpose of this study was to compare PCR rates and the subsequent PCR management costs with the Intrepid Hybrid tip and metal tips. A decision analytic model from the health care provider’s perspective was developed in Excel for a hypothetical cohort of 1,000 cataract surgery patients. The model inputs were informed by targeted literature reviews. PubMed was searched for clinical or experimental studies published since 2010 using terms such as “Intrepid Hybrid tip”, “phacoemulsification or cataract surgery”, and “posterior capsule rupture”. Studies were included if they reported PCR rates (overall or resident-specific) or associated resource use, or if they used the Intrepid Hybrid tip. The model calculated direct (surgical and postoperative management of PCRs) and indirect (loss of revenue due to PCR and fewer referrals) costs in 2019 USD. PCRs occur in 0.60%-2.39% of all cataract surgeries (n=5 studies) and 0.8%-13.0% of resident-performed surgeries (n=8 studies). Each PCR requires 3 additional follow-up visits (n=3 studies) and 10%-69% of PCRs result in vitrectomy (n=3 studies). The Intrepid Hybrid tip was estimated to reduce the incidence of PCR by up to 4x when compared to metal tips based on the torsional power required before PCR upon contact with the capsule in an experimental study. Therefore, the Intrepid Hybrid tip may decrease PCR rates to 0.15%-0.60% for cataract surgery overall, saving health care providers up to $46,634 per 1,000 cases. For resident-performed surgery, the PCR rate may decrease to 0.2%-3.25%, saving up to $121,368 per 1,000 cases. Using the Intrepid Hybrid tip instead of a metal tip during cataract surgeries may help to reduce PCR rates, health care resource use, and costs to health care providers.

Rate of Posterior Capsule Rupture in Phacoemulsification Cataract Surgery by Residents with Institution of a Wet Laboratory Course

Abstract Purpose To determine if a structured surgical wet laboratory curriculum for ophthalmology residents reduced the rate of posterior capsule rupture (PCR) in phacoemulsification cataract surgery. Setting James A. Haley Veterans' Hospital, Tampa, FL. Design Retrospective cohort study. Methods The study assessed resident-performed phacoemulsification cataract cases from 2011 to 2017, after the creation of a wet laboratory course. Primary outcome measure was PCR. If present, timing of complication, dropped lens fragments, and the need for anterior vitrectomies were noted. Self-reported rates of PCR prior to institution of a wet laboratory course (2010–2011) were compared with cases done by residents who completed the course (2011–2017). Results A total of 3,445 cases were reviewed of which 2.44% (84 cases) noted PCR. Of these, 19% (16) had dropped lens fragments, and 60.7% (51) required anterior vitrectomy. Sixty-nine cases documented timing of PCR with the majority, 58%, occurring during phacoemulsification. When comparing rates of PCR in cases done prior to the presence of a wet laboratory course versus after, there was a significant reduction observed (5.20% before vs. 2.44% after). Conclusion In the presence of a wet laboratory curriculum, the rate of PCR decreased dramatically. The average rate was lower than those reported at other training programs (2.6–9.9%). Most PCR occurred during phacoemulsification, suggesting need for further focused instruction in this step.

A comparative study of central corneal thickness changes in bevel-up and bevel-down phacoemulsification

Introduction: Many techniques that have been developed but the risk for corneal endothelium damage and posterior capsule rupture still exist. It is believed that corneal endothelium is minimally damaged when the tip is bevel down in phacoemulsification surgeries. There is a difference between ophthalmologists with respect to the position of tip in phacoemulsification, and hence we conducted this study. Methodology: Thirty patients were evaluated in this study, both eyes of all the patients were operated using phacoemulsification; the right eye of all patients was operated with the bevel-up phaco tip and the left eye of all patients was operated using bevel-down phaco tip. The central corneal thickness (CCT) was taken and compared on preoperative day, immediate postoperatively, and on postoperative day 1, day 14, and 1 month in bevel-up and bevel-down phacoemulsification. Results: The mean CCT on day 14 in bevel-up phacoemulsification was 593.40 ± 18.11 and in bevel-down phacoemulsification was 585.37 ± 26.60, and on day 30 in bevel-up phacoemulsification was 573.53 ± 16.27 and bevel-down phacoemulsification was 561.80 ± 18.20. It can be observed that there was no significant difference in the CCT on day 0, day 1, and day 14; however, on day 30, there is a significant difference in the bevel up versus bevel down. Conclusion: In our study, it was observed that there was no significant difference in the CCT on day 0, day 1, and day 14; however, on day 30, there is a significant difference in the bevel up versus bevel down. Hence, it is observed that the corneal endothelial loss is less in bevel down when compared to bevel-up phacoemulsification.

Retrospective analysis of visual acuity and final refraction after phacoemulsification surgery with intra- or postoperative complications

Objective: The objective of this study was to assess the incidence of complications intra- and postoperative (until the 30th day) of phacoemulsification surgery performed by residents of the third year, and its implications on final refraction and best-corrected visual acuity (VA), compared to those who did not exhibit any complication.Methods: This was a retrospective analysis of 300 medical records of patients who had their surgeries performed from January 2019 to February 2020 by the same three third-year residents. Fifty medical records were excluded. Initial VA logarithm of the minimum resolution angle and final VA with the best correction were analyzed, comparing whether there was a correlation with the presence of complications.Results: Of the 250 medical records analyzed, 29 (11.6%) presented complications during the intraoperative period, been posterior capsule rupture the mean one. The mean VA of patients without complications was 0.13 ± 0.17 (0.00–1.00) compared to 0.29 ± 0.28 (0.00–1.00) for those who had complications. The spherical equivalent of those without complications was −0.87 ± 0.98 (−4.38–2.00) compared to −1.19 ± 1.14 (−3.75–0.50) of the that had.Conclusion: As shown in this study, the percentage of complications is compatible with those found in the literature, also exhibits that surgeries with complications do imply in worst VA. However, when compared among themselves, before and after surgery, there was a significant improvement in the VA even in patients with complications.

Severe Intraocular Pressure Fluctuation following Hemodialysis after Cataract Surgery in a Patient with Chronic Renal Failure

Purpose: To report a case of severe intraocular pressure fluctuation following hemodialysis after cataract surgery in a patient with chronic renal failure.Case summary: A 51-year-old female patient on hemodialysis for chronic renal failure, who was seen regularly by our retina clinic for proliferative diabetic retinopathy and right eye cataract, presented with decreased visual acuity in her right eye. During phacoemulsification under the diagnosis of right eye cataract, zonular dialysis and posterior capsule rupture occurred and intraocular lens ciliary sulcus insertion was performed. Following hemodialysis 3 days after the surgery, the patient complained of headache and right eye pain. The intraocular pressure of the right eye had increased to 44 mmHg. Mild inflammation in the anterior chamber was found with remnant lens material present at the inferior anterior angle. The use of glaucoma eye drops, anterior chamber paracentesis, and anterior chamber irrigation reduced the intraocular pressure and improved the patient’s symptoms. However, a severe increase in intraocular pressure recurred with the above symptoms, again following hemodialysis. Intraocular pressure fluctuation was repetitively present after serial hemodialysis treatments for 1 month, at which point cataract and glaucoma surgeries were considered. However, the intraocular pressure stabilized afterwards; thus, the patient remained under observation and was treated with glaucoma eye drops.Conclusions: Inflammation and a decrease in the aqueous outflow facility due to remnant lens material and the use of an ophthalmic viscoelastic device in cataract surgery may cause severe intraocular pressure fluctuations in patients undergoing hemodialysis for chronic renal failure.

Intravitreal Injection Is Associated with Increased Posterior Capsule Rupture Risk during Cataract Surgery: A Meta-Analysis

Background: Although observational studies have suggested that prior intravitreal therapy may predict posterior capsule rupture (PCR) during cataract surgery, this finding is still controversial. Objective: This study aimed to summarize current evidence on the association between prior intravitreal injection (IVI) and PCR during cataract surgery. Methods: A systematic literature search was performed up to October 27, 2021. Pooled odds ratios (ORs) and 95% confidence intervals (CIs) were calculated using random-effects models. The potential association between IVI and PCR in future cataract surgeries was assessed using the following two models: “pooling the ORs of PCR in eyes with and without previous IVI(s)” and “pooling the ORs for PCR relative to each increase in the number of prior injections.” The quality of included studies was appraised using the Newcastle-Ottawa Scale. Results: Six cohort studies were included in this meta-analysis, with a total of 1,051,097 eyes that underwent cataract surgery. Of these, 7,034 eyes were associated with previous IVI. The pooled odds of PCR in eyes with prior IVI was 2.01 (95% CI: 1.35–3.00) times higher than that of eyes without an IVI history. An increase in the number of previous IVI conferred increased odds of PCR of 1.03 (95% CI: 1.01–1.06). After excluding studies that failed to account for confounders, the significantly increased risk was not altered, and the significant heterogeneity was minimized in both models. Conclusion: This meta-analysis provides evidence that previous IVI significantly increases the risk of PCR during future cataract surgery. The risk of PCR should be discussed preoperatively with patients. Further studies are required to validate our findings and explore the underlying mechanisms.

Pac-Man Method: A New Technique for Nuclear Management Of Posterior Polar Cataract.

We introduce an innovative technique, "Pac-Man", for the nuclear management of posterior polar cataracts and compare it with "Chop in situ" and "Fishbowl" techniques. A total of 60 eyes from 60 patients were randomly assigned to groups A, B, and C, with 20 eyes in each group. Pac-Man, Chop in situ, and Fishbowl techniques were used for groups A, B, and C. In the Pac-Man method, adequate single trench sculpts, and a right-sided lateral sculpt were performed and cracked. The triangular piece was emulsified, after which the rest of the nucleus looked like a "Pac-Man" cartoon. Techniques were compared by age, visual outcome, Posterior Capsule Rupture (PCR), Cumulative Dissipated Energy (CDE), and time of surgery. Postoperative BCVA was significantly improved after surgery (P = 0.0001, paired t-test). Time taken for surgeries were 25 ± 2.57, 30 ± 3.78, 40 ± 3.25 min, the CDE were 10 ± 0.95, 20 ± 1.2, 15 ± 0.48, and the PCR were 0%, 5%, and 10% for group A,B,C respectively. The total number of PCR was 3 out of 60 patients, and the percentage was 5.00%. The "Pac-Man" method is a recommended technique due to its visual outcome, reduced surgical time, less CDE, and less chance of PCR.

Effect of Phacoemulsification and Intraocular Lens Implantation on High Myopia with Cataract

Objective:To observe the clinical effect of phacoemulsification and intraocular lens implantation for high myopia with cataract. Results: To analyze 144 cases (152 eyes) of high myopia with cataract, male 78 cases (84 eyes), female 66 cases (68 eyes); age between 45~81 years old, average 65.26 years old; Axis oculi length 6.47~34.04mm, average 29.82mm. Nuclear lens opacities 86 eyes, Posterior subcapsular opacity 38 eyes, Cortical opacity 28 eyes; Nuclear hardness grading standards by Emery, 42 eyes nuclear grade Ⅱ, 72eyes nuclear grade Ⅲ, 34 eyes nuclear grade Ⅳ, 4 eyes nuclear grade V; Before the surgery, corrects defects of vision ≤0.1 in 120 eyes(79%), 0.1～0.2 in 32 eyes(21%), All patients under the topical anesthesia received the phacoemulsification and intraocular lens implantation. Results: After operation all the patients’ vision 0.5 in 78 eyes(51%), 0.2～0.4 in 56 eyes(37%), 0.1 in 18 eyes(12%), Compared with before operation, the enhancement of vision has a statistics significance(P0.01). Intraoperative, posterior capsule rupture is 2 cases(1.3%); No one has high intraocular pressure after operation, Cornea dropsy is 32 eyes(21%), after 3~7 d anti-SARS, just right for the illness treatments, cornea dropsy abates. After 3~6 months, no one has after-cataract in all patients. Conclusion: This is an effective treatment of phacoemulsification and intraocular lens implantation for high myopia with cataract and may improve the patients’ vision obviously and their quality of life.

Confidence of UK Ophthalmology Registrars in Managing Posterior Capsular Rupture: Results from a National Trainee Survey.

IntroductionTo establish the level of confidence amongst UK ophthalmology specialist registrars (residents) in managing posterior capsule rupture (PCR) during cataract surgery.MethodsAn online nine-item questionnaire was distributed to all registrars, recruited nationwide via regional representatives. Data collected included stage of training, number of completed cataract operations, cumulative PCR rate, number of PCRs independently managed, understanding of vitrectomy settings and fluidic parameters and access to simulation. Respondents self-evaluated their confidence in managing PCR with vitreous loss.ResultsComplete responses were obtained from 248 registrars (35% response rate). Mean number of phacoemulsification procedures performed was 386. For senior registrars (OST 6–7), 35 out of 70 (50%) felt confident to manage PCR independently and 55 out of 70 (78.6%) were either quite confident or very confident at deciding when to implant an intraocular lens during PCR management. Lower confidence levels were noted for junior trainees (OST 1–2). Over 65% of survey respondents had access to relevant simulation.ConclusionsOur results represent the largest UK survey analysing the confidence of PCR management amongst registrars. Confidence improves with duration of training and increased exposure to management of PCR. However, 50% of senior registrars still lacked confidence to independently manage PCR and vitreous loss. A specific competency-based framework, potentially using a simulator or simulating a PCR event, incorporated into the curriculum may be desirable.

Surgeon effects on cataract refractive outcomes are minimal compared with patient comorbidity and gender: an analysis of 490 987 cases

AimTo investigate effect of patient age, gender, comorbidities and surgeon on refractive outcomes following cataract surgery.MethodsStudy population: patients on UK national ophthalmic cataract database on cataract operations undertaken between 1...

Об операционных осложнениях высокотехнологичной факоэмульсификации с имплантацией ИОЛ

Purpose. To analyze the nature, frequency and effectiveness of correction of surgical complications during high-tech phacoemulsification (PE) with IOL implantation. Material and methods. A prospective non-randomized study is devoted to the analysis of surgical complications in patients who underwent outpatient FE surgery with IOL implantation. The results of 3000 consecutive operations (3000 eyes) performed in 2019-2020 at the Eye Surgery clinic were studied. The calculation of the IOL was carried out on the diagnostic system "VERION" (Alcon). All operations were performed in the conditions of 3D visualization using the digital system "NGENUITY® 3D Visualization System" (Alcon). Alcon IOLs were implanted: monofocal, multifocal, toric. Results. During the surgical intervention, 33/3000 (1.1%) surgical complications occurred. The main surgical complication was the rupture of the posterior capsule of the lens-26 (0.86%) of the eyes, mainly without loss of the vitreous body-22 (0.73%). Conclusions. 1. The number of surgical complications during high-tech phacoemulsification with IOL implantation was 1.1%. 2. The main one among them was the rupture of the posterior capsule of the lens-0.86%, mainly without loss of the vitreous body-0.73%. 3. High-tech surgical support of operations and correction of the arisen operational complications allowed to successfully eliminate all complications in all cases. Key words: cataract, phacoemulsification, surgical complications, posterior capsule rupture.

The Learning Curve of the Deliberate Practice of Phacoemulsification in the Ophthalmic Training System

Objective: To determine the number of surgeries needed for trainees to achieve competence in performing phacoemulsification with deliberate practice (DP). Materials and Methods: The present study was a prospective observational study, the residents were observed as they progressed through their third year of residency. Resident and patient demographic data were recorded. Complexities of the cases and surgical steps and rate of surgical complications were recorded. Self and staff assessments as to the DP learning zone attained by the trainees were collected. Risk adjusted-cumulative summation (RA-CUSUM) was used to evaluate the competency of the trainees to achieve the acceptable posterior capsule rupture (PCR) rate of 5%. Kaplan-Meier analysis was used to determine the median number of surgeries required to attain competency. Results: Eight of the 10 trainees achieved competence in performing phacoemulsification. A median of 28 cases and 278 days was required before competence was attained. There were no statistically significant associations between the achievement of competence and the gender of the trainees, perceived complexity of the cases, or the grade-point average of the residents during their tenure in medical school. A median of four cases were required for a shift in the trainees’ DP confidence levels from “panic” to “learning” from self-assessment, while the median of ten case were required from staff assessment. The PCR was 8.53% and dropped to 6% at two years after the trainees finished residency training. Conclusion: Trainees require at least 28 cases of non-complicated phacoemulsification surgery to achieve a minimum level of competency. The perceived skill in performing phacoemulsification differs between novice and experienced surgeons. Phacoemulsification skills can be further developed after graduating from the training program. Assisting staff should be attentive when trainees perform lens nucleus division and lens nucleus removal to avoid complications. Keywords: Residency training; Phacoemulsification; CUSUM; Deliberate practice; Cataract

Establishing the influence of case complexity on the order of cataract lists: a cross-sectional survey

ObjectiveOrder of the theatre list and complexity of the cases are important considerations which are known to influence surgical outcomes. This survey aimed to establish their influence on cataract surgery.Methods...

Managing intraocular lens dislocation with one-port pars plana vitrectomy under direct vision with microscope illumination

AIM: To describe a technique of managing intraocular lens (IOL) with deep dislocation in the vitreous cavity by performing pars plana vitrectomy (PPV) with only one pars plana incision under the direct illumination of the surgical microscope. METHODS: Patients who had in-the-bag or out-of-the-bag (spontaneous) IOL dislocation after uneventful phacoemulsification cataract extractions, with the dislocated IOL or IOL-capsular bag complex dropping completely into the vitreous since 2013 were included in our studies. The postoperative patients were followed up for 6mo. Detailed description of technique and retrospective description of eight typical cases were demonstrated in this study. RESULTS: A total of 40 surgeries were conducted using this technique. The main possible predisposing conditions included: post-vitrectomy, posterior capsule rupture or broken zonules, a history of ocular trauma, long axial length, secondary IOL implantation, chronic uveitis, retinitis pigmentosa and post-glaucoma surgery. In all eyes, the IOLs were successfully removed. No intraoperative or postoperative complications related to the procedures occurred. The preoperative corrected distance visual acuity (CDVA) ranged from 20/133 to 20/25, and at 6mo postoperatively, the CDVA was similar or the same. The intraocular pressure was all within the normal range. CONCLUSION: One-port PPV under direct vision with microscope illumination is a simple and safe surgical technique to managing IOL dislocation, which shortens the surgical time, and largely avoids surgical complications.

Comparison of Complications between Manual Small Incision Cataract Surgery and Phacoemulsification

Purpose: To compare per-operative and early post-operative complications between Manual Small Incision cataract surgery and Phacoemulsification in patients with Senile Cataract.&#x0D; Study Design: Quasi experimental study.&#x0D; Place and Duration of Study: Al-Ibrahim Eye Hospital Karachi from December 2018 to October 2019.&#x0D; Methods: Two hundred and seventy patients with senile Cataract were recruited for this study by convenient sampling technique. They were divided equally into two groups. Group I underwent Manual Small Incision Cataract Surgery (MSICS), whereas Group II underwent Phacoemulsification. Per-operative and early post-operative complications were recorded on day 1 in both groups. Data was analyzed using SPSS 24.0. Independent t-test was carried out with P-value of ≤0.05 was considered statistically significant.&#x0D; Results: Mean age group – I was 54.95 ± 11.0 and in Group – II was 57.09 ± 10.59 (p = 0.546). There were 72 (53.3%) males in group – I and 74 (54.8%) in group – II with a non-significant difference (p-value &gt; 0.01). There was significant difference for posterior capsule rupture and striate keratitis between the two groups (p = 0.031 and 0.044 respectively). Rest of the study parameters was not statistically different in the both group. None of the groups had a nucleus drop and vitreous prolapse. No significant difference was seen between the two groups concerning iris trauma (p = 0.56), wound leakage (p = 0.15) and hyphema (p = 0.32).&#x0D; Conclusion: There is no significant difference between per-operative and early post-operative complications between MSICS and Phacoemulsification in patients with senile cataract except posterior capsular rupture and striate keratopathy which were more common in phacoemulsification group.&#x0D; Key Words: Cataract, Senile Cataract, Phacoemulsification, Small Incision Cataract Surgery.