Small Incision Cataract Surgery Group Research Articles

Assessment And Comparison of Bacterial Contamination in Anterior Chamber Aspirates in Small Incision Cataract Surgery (SICS) And Phaco-Emulsification

Introduction: The rate of occurrence of endophthalmitis after cataract surgery has been reduced to a greater extent now a day. Even then endophthalmitis related consequences are devastating. Several sources of infection, including contamination by air, solutions, surgical instruments, intraocular lens, and wound leakage have been identified. Aim of the Study: The study aimed to evaluate the influence of two methods of surgical technique of cataract surgery in bacterial as well as comparison of contamination by these two techniques. Methods: This prospective observational study was conducted over 60 patients with age related cataract in the department of Ophthalmology and Microbiology in Sir Salimullah Medical College and Mitford Hospital, Dhaka, Bangladesh, from 1st January, 2009 to 30th June, 2009. Patients were selected purposively based on specific selection criteria. Selected patients underwent detail ophthalmic and systemic evaluation as well as relevant investigations. Cataract extraction followed by intraocular lens implantation was planned for all patients. The two techniques of cataract surgery such as SICS and Phacoemulsification were assigned to the patients randomly by 1:1 basis. 1 ml of anterior chamber contents were aspirated through aseptic technique by 26G needle from each patient pre-operatively, after capsulorrhexis (early per-operative) and just before wound closure by stromal hydration (late per-operative). All samples were sent for 10% KOH staining and culture and sensitivity test after proper leveling. Results: Micro-biological examination shows no sample was positive for 10% KOH staining. In SICS group, out of 30 samples 3 were found culture positive, which were positive in 4 and 5 samples in early per-operative and late per-operative sample respectively and in Phacoemulsification group, it was 2, 3, 5 pre-operative, early per-operative and late per-operative sample respectively. The common organisms isolated were Coagulase positive Streptococcus, Corynebacterium species, Streptococcus viridans, and Staphylococcus aureus etc. Almost none of the patients showed clinical activity except few cells and flare in the anterior chamber in early post-operative period. Conclusion: The microbiological examination shows the incidence of microbial contamination of anterior chamber contents is very low after cataract surgery by both form of technique, and there was no statistically significance difference in incidence between these two techniques. J.Natl.Inst.Ophthalmol.2023;6(1): 37-41

Bacterial Contamination Evaluation in Anterior Chamber Aspirates: Contrasting Small Incision Cataract Surgery (SICS) and Phacoemulsification

Introduction: The rate of occurrence of endophthalmitis after cataract surgery has been reduced to a greater extent nowadays. Even then endophthalmitis related consequences are devastating. Several sources of infection, including contamination by air, solutions, surgical instruments, intraocular lenses, and wound leakage have been identified. Aim of the Study: The study aimed to evaluate the influence of two methods of surgical technique of cataract surgery in bacterial as well as comparison of contamination by these two techniques. Methods: This prospective observational study was conducted over 60 patients with age-related cataracts in the Department of Ophthalmology and Microbiology in Sir Salimullah Medical College and Mitford Hospital, Dhaka, Bangladesh, from 1st January 2009 to 30 June 2009. Patients were selected purposively based on specific selection criteria. Selected patients underwent detailed ophthalmic and systemic evaluation as well as relevant investigations. Cataract extraction followed by intraocular lens implantation was planned for all patients. The two techniques of cataract surgery such as SICS and Phacoemulsification were assigned to the patients randomly on a 1:1 basis. 1 ml of anterior chamber contents were aspirated through an aseptic technique by 26G needle from each patient pre- operatively, after capsulorhexis (early per-operative), and just before wound closure by stromal hydration (late per- operative). All samples were sent for 10% KOH staining and culture and sensitivity test after proper leveling. Results: Micro-biological examination shows no sample was positive for 10% KOH staining. In the SICS group, out of 30 samples, 3 were found culture positive, which were positive in 4 and 5 samples in early per-operative and late per-operative samples respectively, and in the Phacoemulsification group, it was 2, 3, 5 pre-operative, early per- operative and late per-operative sample respectively. The common organisms isolated were ......

Changes in central macular thickness before and after cataract surgery evaluated by optical coherence tomography in non-diabetic patient

Background: Optical coherence tomography (OCT) has been useful for objectively observing central macular thickness (CMT) changes inpre-operative and post-operative uneventful cataract surgery. Aims and Objectives: This study was done to compare changes in CMT in small incision cataract surgery (SICS) and phacoemulsification surgery and to illuminate the OCT features of CMT after uneventful cataract surgery. Materials and Methods: A prospective observational study was done at the tertiary eye care center from December 2019 to November 2020, a total of 60 patients underwent SICS and Phacoemulsification cataract surgery, were followed and examined postoperatively at day 1, 1 week, 1 month, and 6 months for whole ocular examination and OCT. Results: Comparison analysis was performed using Friedman’s analysis of variance test.In SICS and Phacoemulsification group, statistical analysis differences between the mean CMT at pre-operative, post-operative 1 week, 1 month, and 6 months were found statistically significant (P > 0.001), subclinical macular edema (increase CMT without affecting visual acuity) was noted at 1 week and 1 month reviews. Conclusion: The changes in CMT after cataract surgery are reversible, since the maximum measured increase in macular thickness at 1 month after surgery then gradually decreased at 6 months follow-up. This increase remained subclinical, and no evidence of clinical cystoid macular edema was seen on OCT.

Visual outcome following clear corneal incision phacoemulsification with rigid intra-ocular lens and small incision cataract surgery in low socioeconomic group patients: A comparative analysis in a teaching hospital in South India

Background: Cataract is the most common cause of curable blindness worldwide. Aims and Objectives: A comparative analysis of clear corneal phacoemulsification with rigid intra-ocular Lens (IOL) and small incision cataract surgery (SICS) in low socioeconomic group patients in terms of post-operative visual outcome, surgically induced astigmatism (SIA), and intra-and post-operative complications. Materials and Methods: A prospective hospital-based comparative study was conducted for 8 months in 424 eyes of 400 senile cataract patients divided into PHACO and SICS groups. Each group consisted of 212 eyes of 200 patients. Detailed examinations for best corrected visual acuity (BCVA), SIA, and complications were evaluated on the 1st post-operative day, 1st week and 6 weeks postoperatively. Results: BCVA 6\18 or higher was 95.38% in the phacoemulsification group and 94.81% in the SICS group. The study revealed good visual outcome in both SICS and Phaco groups with no significant difference. The mean SIA was more in SICS group (−0.96±0.57) than in phaco group (−0.71±0.47) which was statistically significant. In terms of complications, no significant difference was noted between the groups. Conclusion: The outcome of this study indicated that though SIA is more in SICS group than Phaco group, there is no difference between the groups in terms of visual outcome. The study has proven that SICS has comparable effectiveness as phacoemulsification with rigid IOL, which should be considered in low- and middle-income countries.

Comparison of Visual Outcomes between Phacoemulsification and Small Incision Cataract Surgery

Background: Globally, it is approximated that there are around 100 million cases of cataracts resulting in visual acuity of less than 6/60, and this number is expected to increase to approximately three to four times more for cases causing acuity of less than 6/18. Small incision cataract surgery is distinguished by its ability to provide early wound stability, reduce post-operative inflammation, eliminate suture-related complications, necessitate fewer post-operative visits, and have a milder impact on the corneal endothelium. This approach can be applied to all types of cataracts, unlike phacoemulsification, where careful case selection is particularly crucial, especially for less experienced surgeons. Objective: The objective of this study is to compare the visual outcome between Phacoemulsification and Small Incision Cataract surgery. Method: An experimental interventional study was conducted concurrently at Kulsoom Bai Valika Social Security Hospital and Sindh Govt. Qatar Hospital from January 2022 to January 2023. During this study, Phacoemulsification and Small Incision Cataract Surgery (SICS) procedures were performed. The research received approval from the relevant authorities at both hospitals. The study included a total of 200 participants, with one group undergoing SICS and the other group undergoing phacoemulsification, each consisting of 100 patients. To assess the relationship between the two procedures, a statistical analysis employing either the Chi-square or Fischer's test was conducted, and for LogMAR Mann-Whitney test with a P-value of 0.05 was deemed statistically significant. Results: The age difference between the two groups was found to be statistically insignificant, with a p-value of 0.158. The mean age for the SICS group was 54.96 ± 11 years, while the mean age for the Phacoemulsification group was 57.3 ± 12 years. In terms of gender distribution, the SICS group consisted of 47 females and 53 males out of 100 participants, while the Phacoemulsification group had 45 females and 55 males out of 100 participants. The results indicate that there was no significant difference in the mean best-corrected visual acuity (BCVA) between both groups, with a p-value of 0.36. In the Phacoemulsification and SICS groups, 86 and 83 patients out of 100, respectively, achieved a BCVA of 6/6-6/12 [LogMAR (0-0.3)]. Conclusion: The postoperative mean visual acuity in both the SICS and Phacoemulsification groups was found to be similar. Nevertheless, it's noteworthy that the SICS procedure offers significant cost-effectiveness and can be a viable option for cataract treatment, enabling economically disadvantaged patients to achieve excellent vision.

A prospective observational study of changes in intraocular pressure before and after cataract surgery using noncontact tonometer in small incision cataract surgery and phacoemulsification

Purpose: To compare the changes in intraocular pressure (IOP) before and after cataract extraction using noncontact tonometer (NCT) in small incision cataract surgery (SICS) and phacoemulsification. Materials and Methods: A prospective observational study of 100 eyes that underwent phacoemulsification and 100 eyes that underwent SICS with intraocular lens implantation for senile cataract with normal IOP were included. Both groups underwent IOP recording using NCT, preoperatively, postoperatively at the 1st, 4th, and 6th weeks, respectively. Repeated-measure analysis of variance and independent sample t-test were applied to analyze the data. Results: The mean IOP at the preoperative and postoperative 1st, 4th, and 6th weeks was 13.07, 12.24, 11.78, and 11.66 mmHg, respectively, in SICS group and 14.39, 13.94, 13.08, and 12.90 mmHg in phacoemulsification groups, respectively (P < 0.001). Conclusion: A decline in postoperative IOP was present in both SICS and phacoemulsification groups, but a more significant decline was noticed in SICS group.

Surgical Outcomes of Trabeculectomy Alone versus Trabeculectomy with Manual Small Incision Cataract Surgery Following Acute Angle Closure Glaucoma: A Comparative Study

Introduction: Acute Angle Closure Glaucoma (AACG) is an ophthalmic emergency and is managed medically. Therapeutic options for the management of the post congestive phase are varied and no procedure has a documented therapeutic superiority over the other. Two established procedures were therefore chosen and compared to determine their therapeutic efficacy. Aim: To compare the surgical results of combined manual Small Incision Cataract Surgery (SICS) and trabeculectomy with standalone trabeculectomy in patients following an attack of AACG, with a final aim to decide which would be the better therapeutic approach in such a situation. Materials and Methods: This was a prospective observational study done in Bankura Sammilani Medical College located in West Bengal, India. Sixteen patients presenting with AACG in a 19 months study period from October 2019-April 2021 and having 50% or more synechial angle closure on indentation gonioscopy were selected for this study after obtaining necessary ethical clearance. Eight of them underwent trabeculectomy alone (Group A) and the rest underwent a combined procedure of trabeculectomy and SICS (Group B). They were followed-up for a six-months period and compared on the basis of Intraocular Pressure (IOP) control, Anterior Chamber (AC) depth and the requirement for further surgery. Results: Mean IOP following surgery at the end of six weeks in Group A was 15.98±1.56 mmHg whereas in Group B it was 12.01±1.18 mmHg. Results were compared by unpaired t-test, and the difference was statistically significant (p&lt;0.001). Three out of eight patients (37%) in Group A developed cataract which caused a reduction in visual acuity and needed cataract surgery within the six months follow-up period but none of the patients in Group B needed any additional surgery. One patient in Group A needed additional medications due to uncontrolled IOP after surgery but no such event was noted in Group B. Seventy five percent patients in Group A had Grade 2 angles whereas 87% patients in Group B had Grade 4 angles as estimated by Van Herrick’s method. Conclusion: Combined trabeculectomy and SICS offers a better level of postoperative IOP control than trabeculectomy alone, and perhaps offers a better therapeutic option following AACG. Also, the chances of postoperative cataract formation and associated visual debility are eliminated.

A COMPARATIVE PROSPECTIVE STUDY OF EFFICACY AND VISUAL OUTCOME OF PHACOEMULSIFICATION AND SICS IN NORTH INDIAN POPULATION IN AND AROUND LUCKNOW.

PURPOSE: To evaluate efcacy and visual outcome of manual small incision cataract surgery (SICS) and phacoemulsication. METHODS: A prospective, interventional, observational, follow up study was conducted on 120 patients with clinically signicant senile cataract undergoing cataract surgery by either SICS or phacoemulsication, at a tertiary eye care centre in Lucknow. The follow up evaluations were carried out at post-operative day st rd th 1, 1 week, 3 week and 6 week. RESULTS: On rst postoperative day, there was signicantly better visual outcome with phacoemulsication than SICS (p = 0.005) with 80% patients in SICS group and 90% patients in phacoemulsication group, th had best corrected visual acuity (BCVA) better than equal to 6/18. However at 6 week, nal visual recovery was similar in both the groups (BCVA 6/18 in 96.7% in SICS group and 100% in phacoemulsication group) with no statistically signicant difference. There was no signicant difference in overall per operative and post operative complications between SICS and phacoemulsication. SICS and phacoemulsication did not show signicant difference in surgery induced astigmatism (SIA) with SIA of 0.733D and 0.775D in SICS and phacoemulsication group respectively. CONCLUSIONS: Phacoemulsication is superior to SICS in terms of early visual rehabilitation. But there is no signicant difference in nal visual outcome and complication rates between the two techniques.

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. &amp; 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 &amp; post-op 1st day,7th day, 1st month, 3rd month &amp; 6th month. Statistical software SPSS, version 21.0 was used for statistical analysis. Results: In both PHACO &amp; 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 &amp; SICS group with the highest MCFT observed in 1st month follow up i.e., 231.6 micrometer (SD ±7.831) in PHACO group &amp; 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.

Comparative Evaluation of Tear Film Parameters Following Cataract Surgery in Diabetic Patients.

Purpose: To compare the propensity of manual small incision and phacoemulsification cataract surgery in causing tear film dysfunction and dry eye syndrome in diabetic patients. Methods: Diabetic patients in group A underwent manual small Incision Cataract surgery whereas in group B underwent phacoemulsification with similar post-operative regimes. The primary outcome measures were the Ocular Surface Disease Index (OSDI), a Subjective questionnaire. The secondary outcome measures were the Subjective Dry Eye (DE) questionnaire, Corneal Fluorescein staining, Tear meniscus height, Schirmer’s II test, and Tear film break-up time. All parameters were measured pre and then postoperatively. Result: 126 patients were divided into group A (undergoing small incision cataract surgery) and group B (undergoing phacoemulsification). The OSDI and subjective DE scores continued to be worse for Group A until the first month after which they became similar to group B with no statistically significant difference (p-value of 0.726 and 0.347 respectively). The OSDI and subjective DES at 3 months were better in both groups as compared to baseline (p &lt;0.0001). The objective tear film parameters (Schirmer’s, TBUT, TMH, and fluorescein staining scores) showed statistically significant changes from the baseline in both groups but the scores remained in the normal range clinically. Schirmer’s test scores were different between the two groups at three months (p=0.007) in SICS group being higher. Conclusion: Manual Small Incision Cataract Surgery (SICS) causes subjective dry eye symptoms more than phacoemulsification until 1 month of surgery in diabetic patients after which the subjective symptoms become similar to phacoemulsification at 3 months.

COMPARISON OF SURGICALLY INDUCEDASTIGMATISM BETWEEN PHACOEMULSIFICATION AND SMALL INCISION CATARACT SURGERY AT TRIPOLI MEDICAL CENTER

Aim: The aim of study was to check the incidence, amount, type, and course of surgically induced astigmatism and visual sense in temporal 3.5-mm clear corneal phacoemulsification and 6-mm superior scleral incision in Small incision cataract surgery (SICS). Materials and Methods: A total of 200 eyes of 200 patients with a mean age of 62 years were included within the study. Cases were randomly divided into two groups. group A had undergone 3.5-mm temporal clear corneal phacoemulsification and blood type had undergone 6-mm superior scleral SICS. Surgically induced astigmatism was analyzed by SIA software. Results: Mean age in A was 61(±8) years and in group B was 63(±10) years. Mean surgically induced astigmatism in blood group was 1.05(±0.58)D,1.13(±0.52)D, 1.13(±0.56)D, and 1.08(±0.52)D on 1st, 7 th ,21 th, and 45 th postoperative days, respectively. The change from 1st to 45th day wasn't significant. the identical in blood group was 0.75(±0.58) D, 0.81(±0.54)D, 0.88(±0.49)D, and 0.91(±0.47)D 1st, 7th, 21th, and 45th postoperative days, respectively. Surgically induced astigmatism was comparable on all days between the groups. We found significant with the rule and against the rule form of astigmatism post-operatively within the temporal clear corneal incision in phacoemulsification group and in superior scleral incision in small incision cataract surgery group respectively. Conclusion: Surgically induced astigmatism was higher within the the superior scleral group than in 3.5-mm temporal clear corneal group. Clinical outcome of both surgeries was same, as there was no significant difference within the uncorrected postoperative acuity in between the groups.

Comparative Study of Dry Eye Indices Following Cataract Surgery.

This study aims to assess dry eye indices following cataract surgery. A single center descriptive and comparative study was performed. A total of 100 eyes of 100 cases fulfilling the inclusion criteria from 1st June 2017 to 30th May 2018 were enrolled. Out of 100 eyes, 50 eyes each went through manual small incision cataract surgery (MSICS) and phacoemulsification respectively. For objective analysis : schirmer 1 test(ST-I), tear breakup Time(TBUT) along with lissamine Green Surface Staining(LGSS) was performed on pre-operative day, 1st, 4th and 12th week respectively. Ocular Surface Disease Index (OSDI) was done for subjective analysis on pre-operative day and at 12th week. The mean age of the patient was 53.66 ± 7.839 years with 34 (68%) being female in a small incision cataract surgery group. In the phacoemulsification group, mean age was 54.72 ± 7.985 years and 32 (64%) were female. On analyzing the objective dry eye indices: ST-I,TBUT and LGSS at 12thweek was 18.80 ± 7.393 mm, 11.30 ± 5.456 seconds and 1.62 ± 1.193 in Small incision cataract surgery group and 27.10 ± 6.326 mm, 16.60 ± 4.699 seconds and 0.38 ± 0.602 in Phacoemulsification group respectively which was statistically significant. (p< 0.001). Regardless of the type of cataract surgery, dry eye disease is unavoidable affecting both tear quality and quantity postoperatively. In our study, phacoemulsification had lesser effect in dry eye indices than small incision cataract surgery.

COMPARATIVE EVALUATION OF MACULAR THICKNESS AFTER PHACOEMULSIFICATION VERSUS MANUAL SICS IN DIABETIC PATIENTS BY OPTICAL COHERENCE TOMOGRAPHY

Purpose: The main purpose of this study was to compare the macular thickness after uncomplicated Phacoemulsification versus manual SICS in known diabetic patient by OCT.&#x0D; Methods: This study was prospective observational study involving 50 eyes of 50 patients with each arm having 25 patients. Group 1 was operated with Phacoemulsification with foldable IOL through 2.2 mm incision &amp; group 2 were operated with manual SICS through 5.5 to 6.5 mm incision with PMMA IOL implantation. Macular OCT was performed in all patients during preoperative period &amp; day 7 post op, 1st month, 3rd month &amp; 6th month. The data were analyzed by using SPSS software (version22.0 SPSS Inc).&#x0D; Results: The MCFT rose steadily in both group during post operative period with higher rise noted in SICS group throughout follow up. Significant difference in MCFT between Phaco &amp; SICS group were noted with highest MCFT noted in 1st month follow up in both groups i.e. 231.6 micro m (SD+7.831) in Phaco group &amp; 241.08 (SD+7.35) in SICS group. The MCFT returned to near pre OP value by 6th month.&#x0D; Conclusion: 1 Age &amp; Sex has no effect on macular thickness before and after any type of Cataract surgery be it Phaco or SICS.&#x0D; 2 Significant higher macular thickness was observed in SICS group so caution should be taken in SICS patients.&#x0D; Keywords: Phacoemulsification, small incision cataract surgery (SICS), Cystoid macular edema

To study correlation of HbA1c and macular thickness changes in diabetic patients after phacoemulsification and small incision cataract surgery (SICS)

To study the relationship between HbA1c and macular thickness using Optical coherence tomography (OCT) in phacoemulsification and SICS. Retrospective study where 100 eyes of type 2 Diabetes mellitus patients with mild to moderate Non-Proliferative Diabetic Retinopathy (NPDR) were included. 50 PATIENTS underwent uncomplicated phacoemulsification surgery AND REST 50 FOR SICS and were divided into 3 groups based on HbA1c levels – Group 1: &amp;#60;6.5%, Group 2: 6.5%–8% and group 3: &amp;#62;8%. Nine macular subfields as defined by Early Treatment of Diabetic Retinopathy study (ETDRS) were measured using OCT. The HbA1c level of each patient was measured and compared with the macular thickness as well as visual acuity. The macular thickness was found to be significantly higher postoperatively in SICS group (251.54 ± 22.69 μm) than the PHACO group (230.44 ± 26.47 μm) on post-operative day 7 and it further increased to (267.46 ± 43.44 μm) in SICS group as compared to phaco group (244.50 ± 37.30 μm)on postoperative 1 month in group C. CMT was highest if HbA1C levels were more than 8% as compared to other two groups on all post-operative day.No significant difference was found in BCVA between both the groups on 1 month and 3 months post-operatively. This study shows that cataract surgery increases the macular thickness and these increases are significantly higher in the SICS than in PHACO eyes on the POD 7, 1 month and 3 months after surgery, especially if HbA1c levels are more than 6.5%, which resolves to near normal levels in phaco group by POD 3 months. This indicates that phacoemulsification is more preferable surgery then SICS in adults with regard to postoperative increase in macular thickness. Also good control of HbA1c levels significantly decreases post-operative visual problems.

A comparative study of post-operative astigmatism induced by phacoemulsification and manual small incision cataract surgery

Background: Surgically induced astigmatism is the cause of poor postoperative vision even after uneventful cataract surgery.AIM: The aim of the study was to compare the effect of surgically induced astigmatism in SICS and Phacoemulsification after taking the incision in the steepest meridian.Setting: Basaveshwar Hospital, Mahadevappa rampure medical college Gulbarga, Karnataka.Design: Prospective observational study. Material and Methods: A total of 200 eyes of 200 patients with mean age of 62 years were included in the study. Consecutive patients with cataract were randomly assigned to undergo phacoemulsification or manual SICS by a single surgeon experienced in both techniques. Group A underwent SICS (Small Incision Cataract Surgery) and group B had phacoemulsification. Surgically induced astigmatism was analyzed by SIA software.Statistical analysis: Non-parametric method (Mann whitney U test).Results: The measurement of induced astigmatism was taken: dK, the net keratometric change in corneal toricity. Average dK for Group A (SICS) was +0.05 D and for Group B (Phacoemulsification) was -0.53 D. There was a difference of -0.49 D between the two groups in terms of induced keratometric astigmatism. The SICS group actually demonstrated on the average a greater iatrogenic astigmatism than the phacoemulsification group keratometrically. This is clinically or statistically significant (P

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.&#x0D; 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.&#x0D; 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.&#x0D; 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 &amp; 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.&#x0D; Conclusion: In conclusion Uncorrected visual acuity in SICS cases were better than that of ECCE cases with sutures.&#x0D; Journal of National Institute of Neurosciences Bangladesh, 2019;5(2): 185-190

Changes in total, anterior, and posterior corneal surface higher-order aberrations after 1.8 mm incision and 2.8 mm incision cataract surgery

To evaluate changes in corneal higher-order aberrations (HOAs) on the anterior and posterior corneal surfaces after 1.8mm microincision cataract surgery (MICS) and 2.8mm small-incision cataract surgery (SICS). Eye Department, First Affiliated Hospital, School of Medicine, Zhejiang University, China. Prospective case series. Right eyes of patients had MICS or SICS. The preoperative and 1-week and 3-month postoperative distance visual acuity (CDVA) and dry eye-related indices were determined. The corneal total HOAs and Zernike coefficients (3rd and 4th order) over 4.0 and 6.0mm zones, corneal volume, central corneal thickness (CCT), and anterior and posterior corneal astigmatism were measured using a Pentacam HR analyzer. The MICS group comprised 126 eyes and the SICS group 70 eyes. The MICS and SICS groups had similar postoperative CDVA; however, the MICS group had quicker recovery of CCT, corneal volume, and corneal astigmatism. Significantly increased anterior corneal total HOAs were observed in the SICS group over a 6.0mm zone (P<.001). Both groups showed significantly increased posterior corneal total HOAs over both zones (P<.001). Similar changing patterns in individual Zernike terms were observed. The MICS group had quicker recovery of posterior corneal surface coma and trefoil than the SICS group, especially over the 6.0mm zone. Changes in posterior corneal surface total HOAs were correlated with corneal volume changes (P<.01). The data suggest quicker corneal recovery and less change in total and anterior corneal surface corneal HOAs after MICS. Changes in posterior corneal surface HOAs were more pronounced in both surgical groups.

Incidence and pattern of dry eye after cataract surgery

PurposeThe objectives of the study were to identify the incidence and pattern of dry eye after phacoemulsification and manual small incision cataract surgeries. MethodsThe study consisted of two groups of patients - Group 1 underwent manual small incision cataract surgery (SICS) and Group 2 underwent phacoemulsification. The dry eye-related data was collected preoperatively and at 1 week, 1 month and 3 months postoperatively. Ocular Surface Disease Index questionnaire, tear break-up time (TBUT) and Schirmer test – 1 were used to record the type of dry eye. ResultsOne hundred eyes of 96 patients, including 35 (36.5%) men and 61 (63.5%) women with the mean age of 63.1 (±8.3) years were studied. Dry eyes were found in 42% eyes (p < 0.001) of patients at 1 week follow-up. Fifteen percent and 9% of the eyes were dry at 1 month and 3 months after surgery, respectively. There were 34 (53.1%) and 8 (22.2%) dry eyes in SICS and phacoemulsification groups, respectively at one week postoperative follow-up which was a statistically significant difference.Majority of eyes (27/42, 64.3%) had mild dryness. There were significant differences in TBUT at 1 week, 1 month and 3 months postoperatively. At 1 week review, the SICS group had mean TUBT of 10.0 (±0.55) sec as compared to 13.9 (±0.70) sec in phacoemulsification group (p < 0.001). ConclusionIncidence of dry eye is higher in SICS than phacoemulsification due to tear film instability. The clinicians should be conscious about dry eye symptoms and signs in an otherwise healthy eye after cataract surgery.

Phacoemulsification Versus Manual Small Incision Cataract Surgery in Patients With Fuchs Heterochromic Iridocyclitis.

To compare the safety and efficacy of phacoemulsification and manual small incision cataract surgery (SICS) to treat cataract in patients with Fuchs heterochromic iridocyclitis (FHI). A randomized, double-masked, prospective, multicenter study. Consecutive patients with cataract after FHI were randomly assigned to have phacoemulsification or manual SICS by 1 of 2 surgeons experienced in both techniques. Complications (intraoperatively and postoperatively), operative time, visual acuities, endothelial cell counts, and surgically induced astigmatism were compared. At 6 months, 65 (92.8%) patients in the phacoemulsification group and 70 (92.1%) in the manual SICS group had a corrected distance visual acuity of 20/63 or better (P = 0.974). Surgical time was significantly shorter in the SICS group (11.2 ± 2.4 minutes) than in the phacoemulsification group (14.2 ± 3.1 minutes) (P < 0.001). The mean surgically induced astigmatism was 0.8 ± 0.2 diopters (D) in the phacoemulsification group and 1.16 ± 0.2 D in the SICS group (P < 0.001). Endothelial cell counts at 1 week and at 6 months did not differ significantly in the phacoemulsification and SICS groups (t test; P = 0.133 and P = 0.032, respectively). Intraoperatively, 2 (3%) eyes randomized to receive phacoemulsification and 4 (5.3%) eyes randomized to receive SICS had posterior capsular rent (P = 0.465). Both techniques achieved good visual outcomes with low rates of complications. Manual SICS may be a viable alternative for cataract management in patients with FHI in settings with limited access to phacoemulsification.

Phacoemulsification versus small incision cataract surgery in patients with uveitis.

To compare the safety and efficacy of phacoemulsification and small incision cataract surgery (SICS) in patients with uveitic cataract. In a prospective, randomized multi-centric study, consecutive patients with uveitic cataract were randomized to receive phacoemulsification or manual SICS by either of two surgeons well versed with both the techniques. A minimum inflammation free period of 3mo (defined as less than 5 cells per high power field in anterior chamber) was a pre-requisite for eligibility for surgery. Superior scleral tunnel incisions were used for both techniques. Improvement in visual acuity post-operatively was the primary outcome measure and the rate of post-operative complications and surgical time were secondary outcome measures, respectively. Means of groups were compared using t-tests. One way analysis of variance (ANOVA) was used when there were more than two groups. Chi-square tests were used for proportions. Kaplan Meyer survival analysis was done and means for survival time was estimated at 95% confidence interval (CI). A P value of <0.05 was considered statistically significant. One hundred and twenty-six of 139 patients (90.6%) completed the 6-month follow-up. Seven patients were lost in follow up and another six excluded due to either follow-up less than six months (n=1) or inability implant an intraocular lens (IOL) because of insufficient capsular support following posterior capsule rupture (n=5). There was significant improvement in vision after both the procedures (paired t-test; P<0.001). On first postoperative day, uncorrected distance visual acuity (UDVA) was 20/63 or better in 31 (47%) patients in Phaco group and 26 (43.3%) patients in SICS group (P=0.384). The mean surgically induced astigmatism (SIA) was 0.86±0.34 dioptres (D) in the phacoemulsification group and 1.16±0.28 D in SICS group. The difference between the groups was significant (t-test, P=0.002). At 6mo, corrected distance visual acuity (CDVA) was 20/60 or better in 60 (90.9%) patients in Phaco group and 53 (88.3%) in the manual SICS group (P=0.478). The mean surgical time was significantly shorter in the manual SICS group (10.8±2.9 versus 13.2±2.6min) (P<0.001). Oral prednisolone, 1 mg/kg body weight was given 7d prior to surgery, continued post-operatively and tapered according to the inflammatory response over 4-6wk in patients with previously documented macular edema, recurrent uveitis, chronic anterior uveitis and intermediate uveitis. Rate of complications like macular edema (Chi-square, P=0.459), persistent uveitis (Chi-square, P=0.289) and posterior capsule opacification (Chi-square, P=0.474) were comparable between both the groups. Manual SICS and phacoemulsification do not differ significantly in complication rates and final CDVA outcomes. However, manual SICS is significantly faster. It may be the preferred technique in settings where surgical volume is high and access to phacoemulsification is limited, such as in eye camps. It may also be the appropriate technique for uveitic cataract under such circumstances.