Sutureless Small Incision Cataract Surgery Research Articles

Comparative study of anatomical and functional recovery of eye along with patient satisfaction score after small-incision cataract surgery and phacoemulsification cataract surgery.

Functional recovery after cataract surgery depends on the anatomical recovery of the eye. This study compared the improvement in visual function parameters after uniocular manual small-incision cataract surgery (MSICS) and phacoemulsification cataract surgery. This study included 310 patients divided randomly into two groups: 155 who received MSICS (MSICS group) and 155 who underwent phacoemulsification (phaco group) for cataract treatment. Outcome measures assessed included vertical and horizontal keratometry reading. The mean corneal astigmatism tear function measured using Schirmer 1 test results were recorded preoperatively, and on postoperative day 1, day 7, and day 30. Optical coherence tomography (OCT) was done to record the average central macular thickness (μm) on day 7 and day 30. The mean corneal astigmatism and anterior chamber inflammation were more in the MSICS group than in the phaco group immediately postoperatively. However, no statistically significant difference was found between the groups with respect to corneal sensation, mean corneal astigmatism, tear film function, and visual outcomes on postoperative day 30. Uncorrected visual acuity was better in the phacoemulsification group than in the manual SICS group on postoperative day 1, day 7, and day 30 (P < 0.001). Both phacoemulsification cataract surgery and manual small-incision sutureless cataract surgery (MSICS) are safe and effective for visual rehabilitation. Phacoemulsification is the preferred technique where resources are available with the advantages of less mean corneal astigmatism, less anterior chamber inflammation, and better uncorrected visual acuity (UCVA) in the immediate postoperative period.

Effect of small-incision sutureless cataract surgery on the natural course of astigmatism over 10 to 20 years.

To retrospectively assess astigmatic changes over 10 years and 20 years after small-incision cataract surgery. 5 ophthalmic surgical sites in Japan. Retrospective case series. Data were collected from patients who had undergone phacoemulsification and implantation of an intraocular lens through a 2.2 to 2.4 mm incision. Preoperative corneal and postoperative manifest astigmatism were converted to power vector notations: horizontal/vertical (J 0 ) and oblique (J 45 ) astigmatism components. 422 eyes of 422 patients were followed for 10 years, and data preoperatively and at 1 month and at 1 year, 3 years, 5 years, 8 years, and 10 years postoperatively were analyzed. The mean J 0 decreased significantly ( P < .001, repeated measures analysis of variance) with an against-the-rule (ATR) shift of 0.363 ± 0.433 diopter (D) over 10 years, but the mean J 45 did not change significantly ( P = .150). Double-angle plot analyses also showed similar ATR shifts in all astigmatism groups. In the subgroup analysis conducted in 34 patients who were followed for 20 years, J 0 declined significantly ( P < .001) by 0.649 ± 0.576 D, whereas J 45 did not ( P = .516). The postoperative changes in J 0 and J 45 were not significantly different between eyes with preoperative with-the-rule, ATR, or oblique astigmatism. Postoperative astigmatism continued to shift toward ATR during the follow-up period of 20 years after small-incision cataract surgery, which seems to reflect the natural course of corneal astigmatic changes that commonly occur with aging. ATR astigmatic shifts were similar in both pattern and magnitude regardless of the type of preoperative astigmatism.

Astigmatic Changes in Sutureless Small Incision Cataract Surgery

Introduction: Cataract is the main cause of bilateral blindness in Nepal. Surgery is the accepted treatment option for cataract with Small incision Cataract Surgery (SICS) and Phacoemusification being the common procedures being performed with comparable results. Corneal astigmatism has been a byproduct of cataract surgery since the first limbal incision was made with improved techniques. Self-sealing scleral pocket incisions are stable and provides early healing, faster visual restoration and more importantly superior astigmatism control. A variety of scleral incisions are being used in manual SICS, with the aim of keeping the post-operative astigmatism to a minimum. Despite having many techniques of scleral incision, there have been only few studies which compares surgical induced astigmatism (SIA) between them&#x0D; Objective: To determine surgical induced astigmatism following frown, chevron and straight incision forms in suture-less small incision cataract surgery(SICS).&#x0D; Methodology: A prospective study was done on a total of 120 patients aged 40years and above with senile cataract. The patients were randomly divided into three groups where each group received specific incision- Straight, Frown and Chevron. SICS with intraocular lens (IOL) implantation was performed. The patients were compared on 2 weeks and 6 weeks post operatively for uncorrected visual acuity (UCVA), best corrected visual acuity (BCVA) and keratometric reading. Surgical induced astigmatism (SIA) was calculated using the SIA calculator version 2.0. The study was analysed using SPSS version 20.0.&#x0D; Results: At 6 weeks UCVA of 6/18-6/6 was attained by 63.41%, 78.94% and 84.61% of patients in group straight, frown and chevron. However about 97% of patients attained BCVA of 6/18-6/6 in all three groups. Mean SIA was least in Chevron group (0.30 D ± 0.16) and was most in the straight group (1.22 D ±0.36) which was statistically significant.&#x0D; Conclusion: Chevron incision induces the least astigmatism compared to frown and straight incision.

Comparative study of surgically induced astigmatism following small incision cataract surgery with incision placed in superior and temporal meridian

Cataract surgery now a days has become a refractive surgery. It not only improves the vision, but also provides good unaided visual acuity(VA). Sutureless small incision cataract surgery(SICS) induces minimum astigmatism. It also helps in early rehabilitation by faster stabilisation of post-operative refraction.The aim of this prospective observational study was to compare the Surgery induced astigmatism(SIA) and VA following manual SICS with superior and temporal incisions.Consecutive 100 patients in the age group of 40 -70 years with cataract having VA&amp;#60;6/18, having no ocular comorbidities were included in the study. After proper evaluation, 50 patients underwent manual SICS with superior scleral incision and rest 50 with temporal incision. Post operative astigmatism was measured at 4 and 8th weeks. Best corrected VA was checked at 8 week. SIA was calculated at 4 and 8 week post operatively.The statistical analysis was done with the help of SPSS 18 statistical analysis software, measuring p value, mean and standard deviation.The mean SIA in superior and temporal SICS at 4 week was 1.06+/-0.41 DCyl and 0.75+/-0.36 DCyl respectively (p=0.000) and at 8week was 0.99+/-0.31 DCyl and 0.64+/- 0.32 DCyl respectively (p=0.000). The difference of SIA at 4 and 8 week in both the techniques was statistically insignificant.41 patients with superior incision and 43 patients with temporal incision had VA of 6/6 at 8 post operative week.VA was 6/9 in 6 patients with superior incision and 3 patients with temporal incision. Whereas, VA was 6/12 in 3 patients with superior incision and 4 patients with temporal incision at 8 post operative week.VA at 8 post-operative week in both the techniques were comparable.SIA in temporal SICS is significantly lesser than that in superior SICS whereas VA in both the techniques is excellent and comparable.

Visual Outcome and Complications of Manual Sutureless Small Incision Cataract Surgery with Foldable IOL-A Teaching Hospital Based Study

Visual Outcome and Complications of Manual Sutureless Small Incision Cataract Surgery with Foldable IOL-A Teaching Hospital Based Study

The role of small incision suture-less cataract surgery in the developed world.

Manual small incision cataract surgery (MSICS) has recently gone through much refinement and fine tuning. It is often taken as an alternate option for phacoemulsification, especially in developing country. This review will present some insight on its applications especially for developed nations. The role of MSCIS in tackling complex cataracts with stony hard nucleus is fairly established. The role of training residents with MSCIS has certain advantages though debatable. MSCIS is much faster and cost-effective surgical technique often possible in suboptimal condition and avoids the capital and maintenance cost of phacoemulsification. The visual outcome and postoperative complications in both phacoemulsification and MSCIS are comparable. Slightly greater astigmatism in MSICS can be lessened with a slight modification of surgical technique. The successful application of MSCIS in large public health programmes has successfully helped to increase the cataract surgical rate and quality. It is the technique of choice for blindness control programme in developing country. MSICS is established as safe and cost-effective procedure in developing country with results as good as phaoemulsification. Although it may not be the best option for developed nations, it is a valuable skill especially for surgical conversion and to deal with complex and advance cataract cases. Hence, it should be a part of resident training programme in developed world and it should be in the armamentarium of every cataract surgeon.

A Comparative Study of Surgically Induced Astigmatism in Various Incisions in Manual Sutureless Small Incision Cataract Surgery

A Comparative Study of Surgically Induced Astigmatism in Various Incisions in Manual Sutureless Small Incision Cataract Surgery

Assessment of astigmatism in manual and sutureless small incision cataract surgery

Assessment of astigmatism in manual and sutureless small incision cataract surgery

Comparison of Cataract Surgery Techniques: Safety, Efficacy, and Cost-Effectiveness

To compare the safety, efficacy, and cost-effectiveness of manual sutureless small-incision cataract surgery (SICS) and phacoemulsification (Phaco) as treatment options for cataract surgery with focus on intumescent, mature, and hypermature lenses (white cataracts). A systematic search of research articles was conducted to develop an internal database for the investigators' appraisal. Literature searches were conducted by using key words and MeSH terms including cataracts, phacoemulsification, small-incision cataract incision, visual acuity, costs, training, time, and barriers to cataract surgery. The final synthesis included 42 manuscripts. All studies show that both Phaco and SICS are safe and effective techniques to rehabilitate cataract patients, but Phaco is costlier, with its preoperative and postoperative medicines, anesthetic agents, viscoelastic materials, disposables, instrumentation, and intraocular lens (IOLs), and had a steeper learning curve. Small-incision cataract surgery, in comparison, has been shown to be faster and more cost-effective. It is useful in intumescent white, black, brown, and lens-induced glaucoma cataracts and could incorporate recent trends like topical and sub-Tenon anesthesia and temporal incisions. Both give equal best-corrected visual acuity but unaided vision has been shown to be slightly better in Phaco due to lesser astigmatism. The literature points to SICS being more useful for intumescent and hard cataracts and is the preferred technique for less-resourced settings. Small-incision cataract surgery is comparable to Phaco in almost all aspects except postoperative astigmatism.

Résultats fonctionnels de la chirurgie de la cataracte de l’adulte

The treatment of cataract blindness is surgical, allowing restored vision. The purpose of this study was to evaluate the functional results of cataract surgery in adults in a tertiary care referral center. Prospective study of 2012 eyes operated for adult cataract from September 1, 2009 to August 31, 2010 (12 months). The results were analyzed by the Monitoring Cataract Surgical Outcomes software (MCSO). The postoperative functional data and the causes of poor outcomes were identified. A total of 1044 women (51.9%) and 968 men (48.1%) underwent cataract surgery. Mean age was 65 years. Extracapsular cataract extraction (ECCE), and manual sutureless small incision cataract surgery (SICS) with posterior chamber IOL implantation in 98%, were the main surgical techniques. Functional results indicated that 45.5% of our patients had good visual acuity (≥3/10) with current spectacles, 33% had limited visual acuity (1/10-2/10), and 21.6% had poor visual acuity (<1/10). The proportion of patients with good results improved with best spectacle correction to 63%, vs. 22.9% with limited visual acuity and 14.1% with poor outcomes. The causes of poor outcomes were mainly related to surgical complications (42.1%) and refractive errors (34.8%). These results are inferior to WHO standards, which recommend a rate greater than or equal to 80% for good outcomes and a rate below 5% for bad outcomes. The identification of the causes of poor outcomes underscores the importance of improving surgical skills and the need for postoperative refraction.

Structured extracapsular cataract extraction-intraocular lens microsurgical training: Report of a trainee′s experience

The aim was to report the experience an ophthalmologist gained in a structured intraocular lens (IOL) microsurgery training program for the information and benefit of colleagues in ophthalmology training institutions. An ophthalmologist was trained in extracapsular cataract extraction (ECCE)-IOL implant in Aravind Eye Hospital (AEH), Madurai, for a period of 8 weeks. Details of patients operated on, procedures observed, and conferences attended were prospectively recorded in a log book. Training was available in conventional ECCE with posterior chamber IOL (ECCE-PCIOL), small incision sutureless cataract surgery, and phacoemulsification. During the period, this trainee observed a total of 1527 cataract extractions, administered 528 retrobulbar and 1047 facial blocks, and also operated on 75 patients. The trainee gained experience and confidence to perform high-quality, low-cost cataract surgery. Hands-on experience and competence in quality ECCE-IOL implant microsurgery can be acquired in a short period of time in a high-volume cataract center. Trainees can also be exposed to other techniques of cataract surgery. Ophthalmology training centers with diminishing surgical training opportunities can also benefit from this structured training in a high-volume cataract center like Aravind Eye Hospital.

Clincal outcome in conversion from small incision sutureless to phacoemulsification cataract surgery

To investigate the clinical outcome during the conversion from small incision sutureless cataract surgery (SICS) to phacoemulsfication cataract surgery (Phaco). During the conversion period from SICS to phaco, 241 cataract cases were assigned to SICS and phaco surgery procedures. The intraoperative complications and early postoperative outcome were assessed. The 1st day visual acuity outcome (VA 0.5 or better) was lower in phaco grouop (p<0.05), however, the visual acuity outcomes were no longer statistically different at 1 week and 1 month visits (p>0.05 for each visit). Among 193 cases operations in phaco group, 51 cases (26.4%) developed corneal edema at 1 day visit, 13 cases(6.7%) had posterior capsular rapture, 5 cases(2.6%) had zonular rupture, 5 cases (2.6%) failed to implant IOL. These rates were higher than what were found in SICS group. The outcome of phaco cataract surgery is comparable with SICS during this conversion period. Techniques that the surgeons may pay attention to are also discussed.

Late-Onset Cystoid Macular Edema Associated With Small-Incision Cataract Surgery and Inadvertent Entry of Chloramphenicol Ointment into the Anterior Chamber.

The authors report the long-term outcome of a 78-year-old man who experienced inadvertent entry of chloramphenicol ointment into the anterior chamber following small-incision sutureless cataract surgery. The chloramphenicol initially formed a single spherical mass on the interior aspect of the corneal section with no discernable effect on visual acuity. However, in the following 6 years the vision deteriorated with the development of multiple fine droplets within the anterior chamber and cystoid macular edema. An anterior chamber washout and removal of the ointment was performed with a subsequent improvement in vision. The authors discuss risks associated with unsutured corneal wounds and the use of ocular ointments.

Impact of written and photographic instruction sheets on patient behavior after cataract surgery

To evaluate the extent to which patients unnecessarily restrict activities of daily living after routine cataract surgery and to test interventions to increase activity. Day treatment center, London, United Kingdom. In this nonrandomized interventional clinical study, consecutive patients having routine first-eye sutureless small-incision cataract surgery received 1 of 3 of the following postoperative instructions: standard discharge instructions informing patients that they could continue all activities of daily living (standard group), an additional written sheet specifying 9 activities of daily living that are safe to perform (written group), or an additional sheet with photographs of people performing safe activities of daily living (photo group). Three weeks postoperatively, patients answered a questionnaire on whether they had avoided the activities of daily living and if so, why. Each group comprised 50 patients. Sixty-four percent in the standard group reported avoiding 1 or more activities of daily living. The percentage was 44% in the written group (P = .07) and 30% in the photo group (P = .0013). In all groups, the decision to avoid activities was self-directed more than 50% of the time; it was based on the advice of a nurse in 17% of cases and of a doctor in 4% of cases. Many patients unnecessarily avoided activities of daily living after cataract surgery. Providing an additional written sheet did not significantly improve this, whereas a photograph sheet did. Better awareness of the safety and rapid rehabilitation after modern cataract surgery is needed in hospitals and primary care centers.

Postoperative cilium entrapment by clear corneal incision

A 75-year-old man had routine phacoemulsification cataract extraction with posterior chamber intraocular lens implantation in the left eye using a temporal corneal incision and inferior paracentesis. Examinations at 1 day and 1 week were unremarkable; however, at the 6-week assessment, a cilium was noted to have penetrated the external ostium of the paracentesis, with the proximal (follicle) end abutting the internal ostium of the wound. While the cilium was removed without incident, this chance finding may aid our understanding of how intraocular cilia are occasionally discovered following routine small-incision sutureless cataract surgery.

Manual small incision sutureless cataract surgery

目的 比较手法小切口白内障手术(MSICS),常规白内障囊外摘出术(ECCE)和晶状体超声乳化术(Phacoe)3种手术方法的效果.方法191例210眼老年性白内障随机分成3组,每组70眼,分别采用MSICS,ECCE,Phacoe手术方法,均一期植入硬质人工晶状体.就其术后1周视力、手术源性散光、主要手术并发症及手术成本进行比较.结果术后1周裸眼视力≥0.6者,MSICS组多于ECCE组,差异有统计学意义(P＜0.05);MSICS组与Phacoe组比较,差异无统计学意义(P＞0.05).术后1周计算手术源性散光,MSICS组低于ECCE组,P＜0.05;MSICS组与Phacoe组比较,P＞0.05.术中后囊破裂合并玻璃体脱出:MSICS组4眼,ECCE组3眼,Phacoe组3眼.术后第1天角膜明显水肿:MSICS组5眼,ECCE组3眼,Phacoe组5眼.MSICS组与ECCE组手术成本相似,MSICS组手术成本明显低于Phacoe组.结论MSICS疗效优于ECCE,手术成本与ECCE相当.MSICS疗效与Phacoe相比无明显差异,手术成本明显低于Phacoe.MSICS兼备了ECCE的成本优势与Phacoe的效果优势,应为大规模治疗白内障盲的重要手段。

Traumatic expulsive iridodialysis after small-incision sutureless cataract surgery

Phacoemulsification with intraocular lens (IOL) implantation was performed in the right eye of an 84-year-old woman using a small clear corneal incision. Ten weeks after surgery, the patient fell, which caused traumatic iridodialysis and hyphema with expulsion of the iris through the surgical corneal incision. Apart from a transient rise in intraocular pressure, no other complication was identified and the visual acuity returned to 20/20 within 2 months. The IOL remained in situ and undisturbed in the capsular bag, and the retina remained flat, suggesting that an IOL in the capsular bag may provide a stable barrier to prevent tissue loss from the posterior segment.

CATARACT SURGERY AND PROGRESSION OF DIABETIC RETINOPATHY

Patient with diabetes mellitus have a higher prevalence of lens opacity 1and cataractdevelopment at an earlier age than non diabetic.2Cataract in diabetes mellitus decreasesthe visual acuity, makes posterior segment evaluation and laser treatment difficult.Several studies have shown that there is progression of diabetic retinopathy after cataractsurgery. In all studies, criteria for progression of diabetic retinopathy are:a) progression of any form/type or stage of diabetic eye (DE), nonproliferative diabeticretinopathy (NPDR) or proliferative diabetic retinopathy (PDR) to any advanced,recurrent form/ type or stage of NPDR or PDR andb) development of new clinically significant macular edema (CSME) and/or worsening/recurrent of preexisting CSME defined by Early Treatment Diabetic RetinopathyStudy (ETDRS).• More severe the preexisting diabetic retinopathy (DR), much worse the DR aftercataract extraction. The progression of DR after cataract extraction is severe inIntracapsular Cataract Extraction (ICCE) than Extracapsular Cataract Extraction(ECCE) with Intraocular Lens (IOL) and Sutureless Small Incision CataractSurgery (SICS) and Phacoemulcification.• Progression of DR increases with complicated cataract surgery, like posteriorcapsular rupture (PCR), vitreous loss and prolonged surgery.• The first 6 months period is crucial as a minimum period of follow up to detectprogression of DR.• There are other several local and systemic risk factors for the progression of DR,like hypertension, renal failure, ischemic heart disease, high cholesterol andtriglyceride level, pregnancy etc.Key Words: Diabetic retinopathy, cataract surgery, risk factors

High Volume Sutureless Intraocular Lens Surgery in a Rural Eye Camp in India

To describe the use of small incision sutureless cataract surgery (SISCS) that permits high-volume, high-quality, and low-cost surgery. We compared the speed, safety, and visual results of 1190 surgical techniques performed in a public eye camp in India. Intraocular lenses were received by 97% of patients (1154). Surgical techniques used were SISCS, phacoemulsification, and standard extracapsular cataract extraction (ECCE) technique. Postoperatively, 60.0% attained uncorrected vision of 6/24 or better. There was little difference in visual results or complication rates among the three techniques. The most striking finding is the speed of SISCS, which enables experienced surgeons to perform the technique in 3.8 to 4.2 minutes. We believe this surgical technique is of major importance especially in developing nations facing enormous surgical volumes and limited resources.

Unpreserved lidocaine to control discomfort during cataract surgery using topical anesthesia

Purpose: To determine whether intraoperative unpreserved lidocaine further decreases discomfort or pain during sutureless small incision cataract surgery and intraocular lens (IOL) implantation under topical anesthesia.Setting: Outpatient ambulatory surgical center.Methods: In this prospective controlled study, comparable eligible patients were randomized to receive 0.1 cc unpreserved lidocaine 1 % or 0.1 cc balanced salt solution (BSS®) (control group) in double-masked fashion. Study drugs were injected intracamerally 1 minute before phacoemulsification. A predefined uniform pain/discomfort scale was used for assessment during phacoemulsification and IOL insertion. A secondary study using a 0.5 cc dose was also performed.Results: Twenty-six percent in the control group and 9% in the lidocaine group had discomfort pain scores of 2 or more; 10% in the BSS group felt increased pressure or pain during phacoemulsification. In the lidocaine group, discomfort was felt mainly during IOL insertion, possibly as a result of wound manipulation. During phacoemulsification, no patient in the lidocaine group reported pain; 2% felt increased pressure during phacoemulsification. A dose increase to 0.5 cc reduced any intraocular sensation to 3% in the lidocaine group. No patient in either group had significant cell loss or adverse events.Conclusion: Intraoperative lidocaine is safe and effective in controlling intraoperative discomfort.