Title: Visual Outcome and surgically induced astigmatism in manual small incision cataract surgery versus phacoemulsification with rigid 5.25mm PMMA IOLs

Authors: Dr Nalini Birpuri, Dr Sakshi Sahni

 DOI:  https://dx.doi.org/10.18535/jmscr/v6i9.173

Abstract

Introduction

Cataract has been documented to be the most significant cause of bilateral blindness in India where vision <20/200 in the better eye on presentation is defined as blindness. In India, cataract has been reported to be responsible for 50-80% of the bilaterally blind in the country. The first surgical procedure for cataract was displacement of lens into the vitreous cavity introduced by Susruta (600BC). Daviel J (1753) described planned extracapsular cataract surgery. To overcome the pitfalls of conventional ECCE Kelman CD (1967) introduced the technique of phacoemulsification for removing the cataractous lens. The advantages of phacoemulsification are that it can be performed under local anaesthesia, minimal post op complications, early visual rehabilitation and postoperative astigmatism is comparatively less. But it requires more skill and sophisticated equipments which are quite expensive and in an economically weaker country like India, the method needs to be cheap and effective. in order to obtain the advantages of a self sealing sutureless incision at alower cost, ophthalmologist developed another technique called Manual small incision cataract surgery. The final visual outcome has been observed to be similar after MSICS and phacoemulsification. Phacoemulsification with standard 2.8mm incision achieves minimal post op astigmatism but a foldable IOL is a prerequisite for this procedure. One more modification in standard phacoemulsification procedure is to enlarge the incision size to 5.5mm & implant 5.25mm PMMA PCIOL so that on one hand the advantages of phacoemulsification can be retained and on the other hand cost factor is also reduced.

References

  1. Susruta Cataract In: Duke Elder S: System of ophthalmology, Disease of the  lens and vitreous, Glaucoma and hypotony.   Vol . XI, Ist edition.  Henry  Kimpton, London 1969;249-50.
  2. Daviel J. Cataract In: Duke Elder S : System of ophthalmology, Diseases of the lens and vitreous, Glaucoma and Hypotony. Vol-XI, 1st Edition, Henry Kimpton, London 1969; 253-57.
  3. Kelman CD. Phacoemulsification and aspiration : A new technique of Cataract removal. Am J Ophthalmol Soc 1967;64 (1):23-35
  4. Iftikhar S, kiani SA. Sutureless phacoemulsification with implantation of 6mm PMMA IOLs Pak J Ophthalmol 2004;20(2):74-6 
  5. George R, Rapauliha P, Sripriya AV, Rajesh PS, Vahan PV, Praveen S . Comparison of endothelial cell loss and surgically induced astigmatism  following  conventional  extracapsular cataract surgery, manual small - incision surgery and   Ophthalmic Epidemiol 2005; 12(5): 293-97.
  6. Gokhale NS, Sawhney S. Reduction in astigmatism in manual small incision cataract surgery through change of incision site. Ind J Ophthalmol2005;53(3):201-03
  7. Alam M, Iqbal Z: Comparison of visual acuity and Astigmatic changes in phacoemulsification with posterior chamber foldable Vs Non Foldable intraocular lens inplant. Pak J Ophthalmol 2007; 23(2): 73-75
  8. Acar S, Mavi E, Cosar CB , Sakaoglu N. Corneal topographic changes after phacoemulsification through steep axis incision. Int Ophthalmol. 2004; 25(2): 123-28 Eye (lond) 1999;13(pt 3a) :329-35
  9. Tarafder AKMSR, Kader MA, Karim SMR . Small incision cataract surgery (SICS) with posterior chamber intraocular lens (PCIOL)  Implantation is the preferred method of community –based cataract   surgery: study of 100 cases TAJ: journal of teacher association 2009;22:132-5          .
  10. Mishra P . Small incision cataract surgery – Non Phaco SICS. Indian Intaocul Implant Refract J 2003;1: 9-15.
  11. Archana S, Khurana AK, Chawala U . Comparative study of sclero- corneal & clear corneal tunnel incision in manual small incision cataract surgery. Nepal J Ophthalmol 2011;3(5):19-22.
  12. Malik VK, Kumar S, Kamboj R, Jain C, Jain R, Kumar S Comparison of  astigmatism following manual small incision cataract surgery : superior versus temporal approach Nepal J Ophthalmol 2012: 4(1) :54-58
  13. Marek R, Klus A, Pawlik R. Comparison of surgically induced astigmatism of temporal versus superior clear corneal incisions. Klin Oczna 2006;108(10-12):392-96.
  14. Olson RJ, Crandall AS. Prospective randomized comparison of Phacoemuls-ification cataract surgery with a 3.2-mm vs a 5.5mm sutureless incision Am J Ophthalmol. 1998;125(5):612-20.
  15. Rainer G, Vass C, Menapace R, Papanos P, Strenn K, Findl O. Long-term course of surgically induced  astigmatism after a 5.0 mm sclero-corneal valve  incision J Cataract Refract Surg 1998;24 (12) :1642-46.

Corresponding Author

Dr Sakshi Sahni

GMC Jammu, India