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Purpose: To estimate the postoperative astigmatism after small?incision cataract surgery (SICS) done by junior residents at the end of 1 and 3 months. Methods: This observational longitudinal study was conducted at the Department of Ophthalmology of a tertiary eye care hospital and research center. 50 patients enrolled in the study underwent manual small incision cataract surgery by junior residents. Preoperative detailed ocular examination was done, which included keratometric estimation using autokeratometer (GR?3300K). Incision length, distance of incision from the limbus, and type of suturing technique were noted. Postoperatively, keratometric readings were noted at 1 and 3 months. Astigmatism (surgically induced astigmatism [SIA]) was estimated using Hill’s SIA calculator version 2.0. All the analyses were performed using Statistical Package for the Social Sciences (SPSS) ver. 26.0 (IBM Corp., USA) software, and the statistical significance was tested at a 5% level. Results: Out of 50 patients, 54% had SIA between 1.5 and 2.5 D and 32% had SIA of more than 2.5 D. Only 14% had SIA less than 1.5 D at the end of 1 month. While 52% had SIA between 1.5 and 2.5 D, 22% had SIA between 1.5 and 2.5 D and 26% had SIA less than 1.5 D at the end of 3 months. Conclusion: The SIA in most of the SICS done by junior residents was above 1.5 D. It depended mainly on the incision length, its distance from the limbus, and the suturing technique.
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Purpose: The study was conducted to evaluate efficacy of intracameral lidocaine hydrochloride 1% and tropicamide injection 0.02% for anaesthesia and mydriasis in manual small?incision cataract surgery (MSICS) and to report any adverse drug reaction. Methods: This was a randomized, prospective, observational study on 32 participants that took place from October 2021 to March 2022 (6 months). Patients between age group 40� year with nuclear sclerosis cataract and pupil diameter >6 mm in preoperative evaluation were included in the study. Patients with pseudoexfoliation, rigid pupil, senile miosis, history of uveitis, ocular trauma, recent ocular infections, with known allergy to tropicamide, all types of glaucoma were excluded from the study. Results: Thirty?two eyes with nuclear sclerosis cataract who underwent MSICS were studied. Fixed dose combination of 2 ml phenyl epinephrine (0.31%), tropicamide (0.02%), and lidocaine (1%) intracamerally was used for mydriasis and analgesia. More than 7 mm pupillary dilatation was achieved within 20 seconds of injection in 29 cases (90.6%). Mild pain and discomfort was noted in 12 cases (37.5%). Postoperative day 1 unaided visual acuity was in the range of 6/18�12 for all patients and grade 1 iritis was seen in 7 cases (21.8%) which was self?limiting. No adverse event like corneal decompensation or TASS were noted.Conclusion: Thus, Intracameral injection of mydriatic provides rapid and sustainable mydriasis and analgesia for manual SICS
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While ophthalmology as a surgical branch itself has evolved technologically with newer instruments, techniques and procedures; ophthalmic surgical training appears to have stagnated in terms of how it is delivered and how trainees� learning and performance are assessed. This collaborative editorial attempts to identify the lacunae in ophthalmic residency training and highlight how technological tools such as surgical simulators can be incorporated into ophthalmic training even in limited-resource settings with good results
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Learning manual small-incision cataract surgery (SICS) is essential for ophthalmic surgeons as it provides an alternative to phaco-emulsification in complicated cases. Nearly 10% of ophthalmic surgeons are left-handed. Left-handed surgeons do face more difficulties because of their laterality, which have been highlighted in various surveys even in other surgical specialities. Surgical training programs, residency programs, and fellowships have traditionally been designed considering the right hand as the dominant hand. Left-handed surgeons (LHSs) are at disadvantage as they are trained by right-handed surgeons (RHSs), which may result in more initial intra-operative errors. Intra-ocular lenses are also designed such that dialing into the bag is relatively difficult for LHSs. Developing customized training modules for LHSs can help them overcome the laterality challenges and enhance their surgical capabilities. In this article, we herein present a brief description of the SICS technique for LHSs, elaborating the crucial steps and customized maneuvers that, if performed differently, may make surgeries easier for them
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Nucleus delivery is still considered as one of the tough steps in SICS among fresh surgeons, leading to various complications at the verge of completion of surgery which further decreases the confidence and elongates the learning curve among the residents,trainees & fellows. Our new technique 揌ydroexpression� utilizes minimal manipulation and minimal instrumentation to express the nucleus with only hydro-cannula without even use of viscoelastics in AC.
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Purpose: To compare the efficacy and safety of sub?tenon block to peribulbar block with respect to analgesia, akinesia, and complications. Methods: It is an observational study conducted at a government hospital in Karnataka. Seventy patients who came to the ophthalmology OPD for small?incision cataract surgery (SICS) under local anesthesia were included in the study. The participants were divided into two groups of 35 as per the surgeon. The pain was evaluated at the time of administration of the block, during the surgery, and during the postoperative period of 4 h. Akinesia was noted in both the groups and the time of onset of akinesia was noted. Any complications associated with the block such as chemosis or subconjunctival hemorrhage were also noted. Statistical analysis was done using PSS version 25.0, where P < 0.05 was considered significant. Results: The baseline pain score was higher in the peribulbar group (1.57). The onset of akinesia was faster in sub?tenons (90.34 s). Complete akinesia was achieved in 82.9% of patients after peribulbar block. There was no significant difference in complications in both groups. Conclusion: Sub?tenons block is an effective and safer technique of ocular anesthesia for SICS. It can be considered as an alternative to the conventional peribulbar block for SICS.
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Purpose: The purpose of this study was to diagnose CME with the help of optical coherence tomography (OCT) after uneventful cataract surgery to prevent visual deterioration. Methods: This study was conducted on 120 patients, who underwent manual small-incision cataract surgery with posterior chamber intra-ocular lens implantation. Follow-up was performed after the first week, sixth week, and 12th week post-operatively. Detailed examination was performed at each visit along with measurements of central macular thickness using OCT. Statistical analysis was performed using SPSS 22.0. Result: The mean age of the patients was 61.85 � 11.41 years having female preponderance. The pre-operative mean best corrected visual acuity (BCVA) was found to be 0.05 � 0.04, whereas the mean post-operative BCVA was found to be 0.65 � 0.17 at the first week, 0.66 � 0.17 at the sixth week, and 0.67 � 0.17 at the 12th week follow?up. The post-operative mean macular thicknesses at the first week, sixth week, and 12th week post?operatively were documented to be 221.66 � 8.49 ?m, 224.60 � 8.75 ?m, and 219.17 � 8.22 ?m, respectively. Conclusion: A sub-clinical increase in macular thickness occurs even after uncomplicated cataract surgery. The maximum increase was observed after 6 weeks of surgery, which returns to near normal values within 3 months. Comparison of central macular thicknesses pre-operatively and post-operatively at the first week, sixth week, and 12th week suggests a significant correlation
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Purpose: Morphological stability and functional integrity of corneal endothelium are necessary to maintain long-term corneal transparency. When the number of endothelial cells drops below 450�0 cells/mm2, corneal edema, irreversible loss of corneal transparency, and decreased vision occur. There is concern regarding manual small-incision cataract surgery (MSICS) being more harmful to the endothelium in comparison to phacoemulsification. Our study aims to determine which technique maintains the corneal parameters closest to the normal physiological state. Methods: A prospective observational study was conducted over a period of 15 months on 100 eyes, out of which 43 patients underwent phacoemulsification surgery and 57 underwent MSICS. TOPCON SP-1P, Version 1.41, 50� Hz frequency, noncontact specular microscope with pachymeter was used to measure endothelial cell count (ECC) and central corneal thickness (CCT) on four occasions: 1 day prior to surgery and on day 1, 3rd week, and 6th week after surgery. Results: In total, 100 eyes of 100 subjects were studied with no dropout during the study period. The age range was 40� years. There was no statistically significant difference between the preoperative mean ECC and mean CCT in phacoemulsification and SICS groups. A statistically significant difference was observed in the postoperative mean ECC (P < 0.01) and mean CCT (P < 0.001) on day 1 and 3rd week between the phacoemulsification and SICS groups, respectively. The mean endothelial cell loss at 6 weeks was less with SICS but comparable with phacoemulsification. Conclusion: SICS is significantly faster, less expensive, less technology dependent, can deal with all types of cataracts, is relatively safe, and is more appropriate for advanced cataracts.
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Purpose: To explore straight incision technique in terms of efficacy for intraocular pressure (IOP) lowering by small-incision cataract surgery (SICS) trab versus modified 揻rown� incision with triangular scleral flap technique. Methods: This study was done at a tertiary health center. It included 44 eyes diagnosed with cataract and coexisting primary glaucoma that underwent SICS with trabeculectomy using modified 揻rown� incision with triangular scleral flap technique and straight incision in group A (n = 22) and B (n = 22), respectively. Postoperative evaluation was done at first postoperative day, then at the end of first week, third week, and 6 weeks; at the end of third month and finally at the end of sixth months. Data were entered and analyzed via Microsoft Excel sheet and SPSS software using Mann朩hitney U test for averages and Chi-square test for categorical values. Results: Mean preoperative IOP in groups A and B were 38.6 and 29.1 mm Hg respectively, by applanation tonometry. After 6-month follow-up, mean of difference in IOP (preoperative � postoperative) for group A was 20.8 � 8.3 mm Hg and that for group B was 17.2 � 13.5 mm Hg. Conclusion: Capacity of IOP reduction of both techniques was found to be comparable and did not show much difference up to the end of 6 months. Mastering technique of group A (modified 揻rown� incision with triangular scleral flap technique) requires more expertise; the simpler straight incision technique provided in group B may be effectively used by the novice and current era Ophthalmologists to combat glaucoma coexistant with cataract.
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Purpose: To determine the effect of depth of scleral tunnel incision measured by anterior segment OCT on postoperative corneal astigmatism by comparing the change of magnitude of corneal astigmatism between superficial and deep sclerocorneal tunnel incision in manual small?incision cataract surgery (SICS). Methods: Depths of sclerocorneal incision of 72 eyes of patients undergoing uncomplicated manual SICS and attending regular follow?up schedule were assessed with anterior segment OCT at 6?week post?op follow?up. Results: The overall mean ± standard deviation (SD) change of astigmatism for superficial incision, that is, ?399 ?m, was 0.44 ± 0.30 and that for deeper, that is, ?400 ?m, was 0.13 ± 0.48 and the change was significantly higher in ?399 ?m group than in ?400 ?m group (P = 0.003). In both superior and temporal incision locations, the mean ± SD change of astigmatism for ?399 ?m incision was 0.48 ± 0.29 and 0.40 ± 0.30, respectively, and that for ?400 ?m was 0.03 ± 0.34 and 0.23 ± 0.57, respectively. The change of astigmatism was significantly higher in ?399 ?m incision group overall (P = 0.003) and also higher in both superior and temporal incision location groups (P = 0.001 and P = 0.479, respectively). Conclusion: The depth of sclerocorneal incision had a statistically significant effect on the change of astigmatism following manual SICS, with superficial incision (?399 ?m) causing a higher change than deeper incision (? 400 ?m).
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Purpose: The International Council of Ophthalmology?Small Incision Cataract Surgery (ICO?SICS) rubric is a tool to grade SICS steps from novice to competent. The study aimed to evaluate the progress of residents’ surgical skills by using the ICO?SICS rubric and the perceptions of residents and faculties about its use. Methods: This prospective educational interventional study, done in the Ophthalmology department between September 2019 and February?2020 included 14 residents and five faculties. Faculties scored residents’ SICS by ICO?SICS?rubric (four sessions/resident) and helped them identify three steps as “area of focus” to work upon. Feedback was taken using a semi?structured pretested questionnaire. Focus group discussion was done for residents. Data were entered in MS Excel and analyzed using SPSS. Perception analysis presented as percentage of written responses. Results: Step?wise rubric score showed improvement for initial SICS steps and wound closure (P < 0.05). Critical surgical steps and scores for three areas of focus steps showed no statistically significant improvement. Three steps as an area of focus changed partly for 11 residents and completely for three residents at the end of 6 months. Perception analysis of faculty and residents showed that the ICO?SICS rubric is a good tool to record surgical performance, identify steps needing improvement and provide structured feedback hence opined to continue it. Residents considered it as an effective learning and assessment tool. Conclusion: ICO?SICS rubric is a good teaching tool and helps to assess the progress of surgical skills. Identification of areas of poor performance and feedback given motivates them to focus on those areas leading to continuous professional development, resulting in competent surgeons performing SICS surgery independently at the end of the residency
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Purpose: To evaluate various methods of nucleus delivery in manual small incision cataract surgery, with reference to visual outcome, intraoperative, and postoperative complications. Methods: In this prospective randomized interventional study, five groups of 40 cases each were constituted, with reference to nucleus delivery technique: (a) phacosandwich, (b) fishhook, (c) irrigating vectis, (d) viscoexpression, and (e) anterior chamber maintainer (ACM). Visual outcome, intraoperative, and postoperative complications were evaluated in detail. Follow-up was done on first and seventh postoperative days (PODs) and then at fourth and eighth postoperative weeks. Results: The most common intraoperative complication was intraoperative miosis, followed by intraoperative hyphema, seen more in phacosandwich and irrigating vectis groups. The most common postoperative complication was striate keratopathy followed by transient postoperative corneal edema and AC inflammatory response, seen more in phacosandwich and fishhook groups. With reference to visual acuity, on the first POD 95% cases of ACM group achieved visual acuity >+0.5 logMAR unit. The difference in the visual outcome among groups was statistically significant. On fourth and eighth postoperative weeks, best-corrected visual acuity among various groups was comparable. Conclusion: ACM and viscoexpression are effective techniques for early visual rehabilitation. Fishhook has limited utility in softer nuclear grades and black cataracts. Phacosandwich is more suitable for nuclear sclerosis Grades 3–4. Irrigating vectis, viscoexpression, and ACM technique are effective techniques for all grades of nucleus Postoperative surgical-induced astigmatism was comparable in all techniques.
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Background: To compare High Vs. Low Volume SIC Surgery Outcomes in tertiary Institute in Central India,in terms of Quality as gauged by Visual acuity parameters at 1 month follow-up. Methods: A prospective, randomized, observational study done on 230 eyes of 230 patients at a tertiary Institute In Central India, with a total duration of 4 months. Patients underwent MSICS by 3 experienced surgeons & were divided into 2 groups:(A) patients coming in low volume season (summer month) & (B)patients in the high volume season (winter month). BCVA in these 2 groups were compared at 1 month follow up. Independent T test was used for analysis. Results: In high vs. low volume setting Best Corrected Visual Acuity (p=0.06) was not statistically significant at 1 month follow up. Conclusions: Gauged in Visual Acuity parameters, High Volume MSICS does not affect the quality when compared with Low Volume MSICS Surgery over a 30-days period in a tertiary institute in Central India.
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Background: To study the role of nonsteroidal anti-inflammatory Nepafenac 0.1% topically in comparison to topical steroid for controlling postoperative inflammation after cataract surgery. Methods: Prospective randomized controlled trials were given and double blind study was done. In both groups, similar baseline parameters were taken into consideration. Postoperative inflammation, intraocular pressure and visual acuity following routine small incision cataract surgery were assessed in both groups in first 21 days. Parameters were graded according to severity. Results: There was not much difference statistically in two groups in the treatment of any of the signs, including ciliary congestion, aqueous cells, flare, descemet’s folds, visual acuity and intraocular pressure (p 0.001) however, there was apparent improvement with corticosteroids when aqueous flare was considered but with Nepafenac there was no side effect and was well tolerated. Conclusion: Nepafenac is equally effective as topical steroid and can safely be used in routine postoperative inflammation after uncomplicated cataract surgery.
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Introduction: Small incision cataract surgeries may be performed using various surgical incisions, namely, superior, supero-temporal and temporal. Each method has its own advantages and disadvantages. Supero-temporal incision is considered the best as it produces least induced astigmatism. The purpose of this study was to compare the postoperative induced astigmatism in superior and superotemporal incision group in small incision cataract surgery. Material &Method- This study was conducted on cataract surgery patients admitted in M.R.A Medical College, Ambedkarnagar. Fifty patients were selected for study, out of which 30 received superior and 20 received superotemporal incision. Preoperative keratometric and post operative 6 weeks keratometric readings were analysed. Results-Superior incision is better for with the rule astigmatism and worst for against the rule astigmatism, while superotemporal incision is equally good for both with the rule and against the rule astigmatism. Conclusion-Superotemporal incision is better than superior as it produces least astigmatism with good visual acquity.
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Background: Age related cataract is the leading cause of blindness and visual impairment throughout the world. With the advent of microsurgical facilities simple cataract extraction surgery has been replaced by small incision cataract surgery (SICS) with posterior chamber intra ocular lens implant, which can be done either with clear corneal incision or scleral incision. Objective: To compare the post operative visual outcome in these two procedures of cataract surgery. Materials and method: This comparative study was carried out in the department of Ophthalmology, Delta Medical College & Hospital, Dhaka, Bangladesh, during the period of January 2010 to December 2012. Total 60 subjects indicated for age related cataract surgery irrespective of sex with the age range of 40-80 years with predefined inclusion and exclusion criteria were enrolled in the study. Subjects were randomly and equally distributed in 2 groups; Group A for SICS with clear corneal incision and group B for SICS with scleral incision. Post operative visual out come was evaluated by determining visual acuity and astigmatism in different occasions and was compared between groups. Statistical analysis was done by SPSS for windows version12. Results: The highest age incidence (43.3%) was found between 61 to 70 years of age group. Among study subjects 40 were male and 20 were female. Preoperative visual acuity and astigmatism were evenly distributed between groups. Regarding postoperative unaided visual outcome, 6/12 or better visual acuity was found in 19.98% cases in group A and 39.6% cases in group B at 1st week. At 6th week 6/6 vision was found in 36.3% in Group A and 56.1% in Group B and 46.2% in group A and 66% in group B without and with correction respectively. With refractive correction, 6/6 vision was attained in 60% subjects of group A and 86.67% of group B at 8th week. Post operative visual acuity was statistically significant in all occasions. Postoperative astigmatism of >0.50D was in 82.5% subjects of group A and 52.8% subjects of group B at 1st week. At 6th week postoperative astigmatism of less than 1D was in 79.95% subjects of Group A and 83.34% subjects of Group B. About 20% subjects in Group A and only 3.3% in Group B showed astigmatism of more than 1D and these differences on both the occasions were statistically significant. Conclusion: The post operative visual outcome was better in SICS with scleral incision (group B) than in SICS with clear corneal incision (Group-A). Keywords: SICS; clear corneal incision; scleral incision; astigmatism.