A Comparative Study of Early Post Operative Corneal Complications of Manual Small Incision Cataract Surgery by Four Techniques of Nucleus Expression

Abstract

AIM:To study the early post-operative corneal complications arising from the 4 techniques of nucleus expression. To study the resultant post-operative visual acuity from the 4 techniques of nucleus expression. MATERIALS AND METHODS: 100 patients with senile cataract were selected from those attending ophthalmology OPD, M. S. Ramaiah Medical College and those attending camps. They were divided by simple random sampling into 4 groups of 25 patients each. The 1 st group underwent standard small incision cataract surgery by phacosandwich technique. The 2 nd group by vectis with counter pressure, 3 rd group by phacofracture and the last group by irrigating vectis technique. The resultant corneal complications and visual acuity were studied on postoperative day 1 and day 7 RESULTS: Chi square test was used for comparison of corneal complications and ANOVA test was applied for comparison of visual acuity by the 4 different techniques. The commonly encountered corneal complications were striate keratopathy and corneal edema. On the first post-operative day, corneal complications were seen in 36% of cases each in phaco sandwich and vectis with counter pressure groups, 40% in the irrigating vectis group and 56% in the phaco fracture groups. Although not statistically significant, the phaco fracture group was associated with more corneal complications. By day 7, only 4% each in the phaco sandwich group and irrigating vectis group had faint SK. None of the patients in the vectis with counter pressure group had any corneal complications. In the phaco fracture group, 16% had faint SK and 4% had pigments on the endothelium. The post-operative visual acuity was studied on day 1 and 7. On day 1, Visual acuity of 6/12 or better was seen in 24% of the patients each in the phacosandwich and irrigating vectis groups, 20% in the vectis with counter pressure group and 16% in the phacofracture group. Visual acuity of 6/60 or less was seen in 8% in the phacosandwich group, 4% in the vectis with counter pressure group, 28% in the phaco fracture group and 4% in the irrigating vectis group. The phacofracture group had a higher incidence of poor vision on day 1. By the 7 day, visual acuity of 6/12 or better was seen in 76% in the phacosandwich group, 88% in the vectis with counter pressure group, 84% in the irrigating vectis group and only 44% in the phacofracture group. CONCLUSION: In the management of senile immature cataracts with nuclear sclerosis grade 2 or less, phacosandwich, vectis with counterpressure and irrigating vectis are equally effective. Phacofracture technique was associated with higher rate of corneal complications in the early post-operative period. Vectis with counterpressure gave the best results causing the least corneal complications. Hence vectis with counterpressure is a safe and effective technique in the management of soft cataracts. Phacosandwich and irrigating vectis techniques also gave comparable results with few corneal complications and fast visual recovery.