Endothelial cell loss is a key indicator of the quality of anterior segment surgery like cataract surgery. The amount and integrity of corneal endothelial cells are the two most essential factors determining corneal transparency.Aim of this study was to compare the endothelial cell loss between the superior scleral tunnel incision and the temporal clear corneal incision for phacoemulsification.Prospective observational study.  This prospective observational study included 50 patients with grade II and III cataracts undergoing phacoemulsification with a temporal clear corneal incision and 50 patients with a superior scleral tunnel incision. Specular microscopy was used to count ocular endothelial cells before and one month after the surgery.The mean endothelial cell loss was significantly higher with temporal clear corneal incision (14.91% ± 5.13%) in comparison to the superior scleral tunnel incision group (6.58% ± 2.06%). A superior scleral tunnel incision is associated with less postoperative endothelial cell loss as compared to a temporal clear corneal incision and could provide a better visual outcome.

We report a case of pseudo exfoliation (PEX) Pseuoexfoliation Sundrome (PEX) syndrome is relatively common but easily over looked condition of eye. It predisposes the eye to open angle glaucoma. There is deposition of grey-white, extra cellular material in anterior chamber (trabeculum, lens capsule, iris, pupil, ciliary body). It is produced by abnormal basement membranes of aging epithelial cells. Cataract surgery is more hazardous in these cases due to poorly dilating pupil, weak zonules and vitreous loss.1 The zonulopathy in PXF is diffuse and progressive, so dislocation of IntraOcular Lens (IOL) may be seen years after cataract surgery. Case historyA 60 year old male patient presented with sudden diminution of vision in Left eye (LE). There was no history of trauma to eye. On slit lamp examination his Right eye (RE) had decentred IOL (Figure 1) and LE was aphakic (Figure 2). His iris and pupil had grey-white material deposited over it. His cataracts were operated with IOL in 1988 with good postoperative visual recovery. (History regarding capsulotomy or capsulorhexis was not available). So we further investigated him with indirect ophthalmoscopy, his IOL in LE was found to be dropped in vitreous cavity. Patient gave history of early maturation of cataract at the age of 40 years. He was high myopic before cataract surgery (-6D Sph Both eyes). Patient was a regular follow up for glaucoma treatment He Dr S N Medical College, Jodhpur. Correspondence to : Dr.Anand Kumar Kulariya E-mail : anandkulariya@yahoo.co.in had been putting Timolol 0.5% since last 10 years .On direct ophthalmoscopy both eyes had glaucomatous cupping (RE>LE). RE had glaucomatous optic atrophy. His IOP by applanation tonometer found in RE and LE were 17 and 18 mm Hg respectively. On pachymetry reading of his cornea was found to be thin (RE 490 micron and LE 480 micron). His visual field reports and OCT revealed progressive glaucoma damage to eyes. After refraction his vision improved to 1/60 (-2.0D Sph with-1 at 90) in RE and 6/9 (+6D sph with +1.25 at 165) in LE. His visual status has remained stable during subsequent follow-up. As patient was myopic and had glaucoma, removal of dropped IOL and secondary IOL implant was not advised by vitreoretinal surgeons as LE was only seeing eye. So we did not remove IOL and give aphakic