Complications of manual small-incision cataract surgery.

The manual small-incision cataract surgery (MSICS) is instrumental in tackling cataract-induced blindness in developing countries, especially with a sizeable proportion being hard brunescent cataracts. MSICS has a unique set of complications related to wound construction, the creation of the capsular opening, and the technique of nuclear delivery. A poorly constructed sclero-corneal tunnel or a small capsulorhexis hampers the nuclear extraction, and the extensive intracameral maneuvers increase the chances of postoperative corneal edema and iritis. Though MSICS has been shown to have universal applicability, producing replicable visual outcomes requires a significant learning curve. This article reviews the relevant published literature on complications of MSICS utilizing the databases of PubMed, Medline, Cochrane, and Google Scholar.

Evaluation of cautery in manual small-incision cataract surgery.

Purpose: Manual small-incision cataract surgery (MSICS) has a major role in tackling cataract blindness in our country. Cauterization of sclera is one of the important steps performed in MSICS to have bloodless field during surgery. Only few studies have addressed the effect of cautery on post-operative astigmatism. The present study is designed to evaluate the effect of cautery on surgically induced astigmatism in Indian patients. Methods: The study was designed as a prospective randomized trial conducted in a tertiary health care institution over a period of 2 years. A total of 150 eyes were randomized into two groups. The study group (Group 1, n = 75) underwent MSICS with cauterization using wetfield bipolar cautery with 4 amperes power. In the control group (Group 2, n = 75), no cauterization was performed. Surgically induced astigmatism was calculated using Naesers polar value method and compared between these two groups up to 60 days post-operatively. Results: Data from 150 eyes were available for evaluation. The net post-operative astigmatic value was 1.01 ± 0.21, 1.04 ± 0.19, and 1.03 ± 0.22 D on the 1st, 7th, and 30th post-operative days, respectively, showing a stable trend in patients undergoing cauterization. In Group 2, the net post-operative astigmatic values observed were 0.47 ± 0.11 D, 0.54 ± 0.10, and 0.54 ± 0.09 D on the 1st, 7th, and 30th post-operative days, respectively. The mean value of surgically induced astigmatism at 2 months post-operatively with and without cautery was 0.60 ± 0.20 D at 90° and 0.47 ± 0.10 D at 90°. The difference was not statistically significant (P = 0.08). Conclusion: The results of this study show that the use of cautery in MSICS is not associated with a higher surgically induced post-operative astigmatism. The magnitude of surgically induced astigmatism decreases with time.

Bimanual capsulorrhexis using Sinskey hook.

An adequately sized, intact capsulorhexis is a key to the outcome of any phacoemulsification procedure. Cystitome is widely used to create a continuous curvilinear capsulorhexis. A 'frozen' capsule (crumpled capsule) mixed with viscoelastic and cortex, however can result in loss of control while using a cystitome. The Sinskey's hook introduced through the side-port, can stabilize the globe as well as work in coordination with the cystitome to spread out the jumbled up anterior capsule allowing visualization of the tear edge in the Bimanual technique. The capsulorhexis is thereby completed comfortably obviating the need of capsulorhexis forceps or repeated injection of ophthalmic viscosurgical device.

Bilateral actinomycotic blepharokeratoconjunctivitis.

Actinomycotic conjunctivitis is usually unilateral and secondary to canaliculitis. We report an unusual case of bilateral actinomycotic blepharokeratoconjunctivitis in the absence of canaliculitis. Keratitis occurred without any preceding ocular trauma. Both eyes had remissions and relapses in response to the antibiotic-steroid drops. Diagnosis of A. israelii infection was made on the basis of Gram staining, culture and biochemical characteristics. Complete excision of the conjunctival ulcer along with penicillin therapy resulted in cure. This case highlights that microorganisms of the order Actinomycetales should be considered in the differential diagnosis if conjunctivitis or keratitis shows a waxing and waning course.