Comparison of visual outcomes and complications of manual small incision cataract surgery (MSICS) and phacoemulsification in brunescent cataract: a retrospective analysis of 350 eyes

Session Details

Session Title: Cataract Surgery Special Cases

Session Date/Time: Tuesday 25/09/2018 | 08:00-10:00

Paper Time: 08:48

Venue: Room A3, Podium 1

First Author: : S.Ravilla INDIA

Co Author(s): :    J. Rajendran   S. Narendran                 

Abstract Details

Purpose:

Cataract is still the major cause of blindness in developing countries.Due to several socio-economic barriers, the percentage of patients presenting to the hospital for cataract surgery with advanced cataract in developing countries is much higher than in developed countries.The increased nuclear density and rigidity makes cataract surgery in brunescent cataracts highly challenging.The aim of this study was to compare the visual outcomes and intra-operative and post-operative complications of MSICS and phacoemulsification in brunescent cataracts.

Setting:

Aravind Eye Hospital, Udumalpet

Methods:

This was a retrospective study in which the medical records of all patients who had undergone cataract surgery for brunescent cataract at a single surgical center between August 1,2012 and December 31,2016 were reviewed.The surgical technique for brunescent cataract removal (MSICS or phacoemulsification) was decided by the operating surgeon.Pre and Postoperative assessment included uncorrected visual acuity (UDVA), best-corrected visual acuity (CDVA) and slit-lamp examination. The postoperative complications were graded as per the Oxford Cataract Treatment and Evaluation Team (OCTET) classification.

Results:

During the study period, 306 eyes and 53 eyes with brunescent cataract underwent MSICS and phacoemulsification(phaco) respectively. .The mean age in the MSICS group was significantly higher(p<0.001).The preop UDVA was significantly worse in the MSICS group (p<0.001) while there was no significant difference in the postop Day 1 (p=0.65) and Day 30 CDVA (p=0.55) between the two groups.Posterior capsular rupture(PCR) was the most common intraoperative complication seen in the Phaco group(3.77%) while whole capsular bag removal was the most common in the MSICS group(1.5%).There was no siginificant difference in the postoperative complications with striate keratopathy being most common.

Conclusions:

Age and preop UDVA are the main determining factors influencing surgeon decision for MSICS over phacoemulsification in brunescent cataracts.The postop CDVA between the two groups is comparable however MSICS group has slightly lesser day 30 UDVA because of the higher surgically induced astigmatism. Though the intraop complication rates between the two groups are comparable the complication profile is different between the groups. Descemet membrane detachment and whole capsular bag removal are more common in MSCIS while PCR and nucleus drop are common in Phaco. The visual outcomes and safety of both MSICS and phaco are comparable for brunescnt cataracts.

Financial Disclosure:

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