Sanjana Marijogaiah Singasandra

Abstract

Background: Most commonly performed surgical procedure in Ophthalmology is cataract extraction by MSICS and Phacoemulsification. It has always been associated with damage to endothelium of cornea, a layer which is vital for maintaining corneal transparency. The corneal endothelium regulates stromal hydration and maintains the transparency of the cornea by constantly removing the fluid out of the corneal stroma. The density of corneal endothelial cells and its integrity is an important determinant for corneal transparency. Post-operative corneal decompensation leading to reduced visual acuity can occur as a result of this surgical trauma. Hence it is necessary to determine the surgical technique safest to corneal endothelium. Specular microscopy helps to determine this corneal endothelial cell density. Materials and Methods: A hospital based longitudinal study was done from November 2017 to May 2019 in 124 patients at Minto Ophthalmic Hospital. 62 patients underwent MSICS and 62 phacoemulsification. After a written informed consent patients were evaluated with detailed history, slit lamp examination, direct and indirect ophthalmoscopy, biometry, lacrimal syringing, IOP measurement with tonometry and endothelial cell count was evaluated using non contact specular microscopy preoperatively and postoperative 1 week and 6 weeks. Statistical data analysed by unpaired – t test. Results: The mean ECC (cells/mm) in MSICS and phacoemulsification group preoperatively was 2486.82 + 152.730 and 2433.71 + 192.692 respectively. The mean endothelial cell loss (cells/mm) was 314.61 + 64.428 and 324.31 + 30.67 at 1 week and 345.71 + 66.68 and 354.95 + 53.885 at 6 weeks postoperatively between the two groups. The endothelial cell loss was not statistically significant at 1 week (p -0.28) and 6 weeks (p-0.39) postoperatively between the two groups. Conclusion: There was no clinically or statistically significant difference in the endothelial cell loss between MSICS and Phacoemulsification. As MSICS is economical and less dependent on technology, it can be a safe option in developing world.   Keywords: MSICS, Phacoemulsification, Specular microscopy, endothelial cell loss

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Abstract

Background: Phacolytic glaucoma is one of the commonest cause of secondary glaucoma due to senile cataracts. This study was conducted to evaluate the visual outcome of phacolytic glaucoma. Objectives: 1. To study the management of phacolytic glaucoma; 2. To study the visual outcome after planned manual SICS. Materials and Methods: Participants were 30 patients in a tertiary eye care hospital for both urban and rural population diagnosed as phacolytic glaucoma. Demographic data, duration of the symptoms, IOP of the patients before presenting to the hospital were noted. Patient underwent Manual SICS with PCIOL implantation after the control of intraocular pressure and inflammation. The data was analyzed by simple statistical methods. Results: Mean age of the patients was 61.63 yrs. Female to male ratio was 1.8:1. Duration of the presenting symptoms before reporting to the hospital was 2 week in 3 (10%). Mean IOP was 40.7mmHg preoperatively. Visual Acuity was perception of light in 16 (53.33%) and hand movements in 14 (46.66%) preoperatively. Postoperative visual acuity at 6 weeks was 6/6-6/12 in 19(63.33),6/18-6/60 in 8 (27%), Conclusions: Cataract surgery proves to be effective in lowering the intraocular pressure and visual recovery in phacolytic glaucoma. Keywords : Phacolytic glaucoma, SICS

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