Evaluation of complications and visual outcome in various nucleus delivery techniques of manual small incision cataract surgery

Abstract

Purpose: To evaluate various methods of nucleus delivery in manual small incision cataract surgery, with reference to visual outcome, intraoperative, and postoperative complications. Methods: In this prospective randomized interventional study, five groups of 40 cases each were constituted, with reference to nucleus delivery technique: (a) phacosandwich, (b) fishhook, (c) irrigating vectis, (d) viscoexpression, and (e) anterior chamber maintainer (ACM). Visual outcome, intraoperative, and postoperative complications were evaluated in detail. Follow-up was done on first and seventh postoperative days (PODs) and then at fourth and eighth postoperative weeks. Results: The most common intraoperative complication was intraoperative miosis, followed by intraoperative hyphema, seen more in phacosandwich and irrigating vectis groups. The most common postoperative complication was striate keratopathy followed by transient postoperative corneal edema and AC inflammatory response, seen more in phacosandwich and fishhook groups. With reference to visual acuity, on the first POD 95% cases of ACM group achieved visual acuity >+0.5 logMAR unit. The difference in the visual outcome among groups was statistically significant. On fourth and eighth postoperative weeks, best-corrected visual acuity among various groups was comparable. Conclusion: ACM and viscoexpression are effective techniques for early visual rehabilitation. Fishhook has limited utility in softer nuclear grades and black cataracts. Phacosandwich is more suitable for nuclear sclerosis Grades 3–4. Irrigating vectis, viscoexpression, and ACM technique are effective techniques for all grades of nucleus Postoperative surgical-induced astigmatism was comparable in all techniques.

A study of visco assisted mechanical pupil stretching for nucleus prolapse in cases of non or mid dilating pupil during small incision cataract surgery

“…18,19 In 43.3% patients pupillary dilatation 4.6-5 mm was achieved post visco elastic stretching. 20,21 Miosis was the most common intraoperative complication observed following nucleus delivery (seen in all dense cataract) which may be attributable to intraoperative manipulations 22 .In dense cataracts engaging the nucleus by fishhook technique 22 was facilitated by 6 point stretch pupilloplasty and viscodissection .IFIS although associated with use of Tamsulosin, can be present otherwise also .In our study iris billowing and floppiness, tendency to prolapse into the incision and progressive intraoperative miosis was noticed. 10 This may be avoided by gentle hydrodissection, lowering the irrigation inflow rate, directing the irrigation currents away from pupillary margin and strategic use of visco elastics to weigh the iris down.…”

“…In this study, gentle and minimal instrumentation, judicial use of ocular viscoelastic devices helped in managing mid/non dilating pupil, maintaining the anterior chamber and avoiding iris prolapse. Zonular dialysis due to extension of anterior capsular tear, posterior capsular rupture and vitreous loss 5,22 can occur in cases of non/dilating pupil during nucleus delivery if any of these maneuvers are done vigorously and repetitively.…”

“…Strategic management of small pupil is imperative for a successful visual rehabilitation after cataract surgery and the focus must be upon avoiding post operative complications such as corneal edema, striate keratopathy, anterior chamber inflammatory response, severe uveitis, retained cortical matter and altered pupil shape. 5,22…”

Incidence of and Risk Factors for Postoperative Hyphema After 23-Gauge Pars Plana Vitrectomy for Proliferative Diabetic Retinopathy

“…1 The most common cause is ocular trauma (blunt or penetrating); 2 however, it can also develop as a result of non-trauma-related conditions, such as iris neovascularization, melanoma, juvenile xanthogranuloma, retinoblastoma, leukemia, and medication-induced anticoagulation. 3 In addition, hyphema can develop after ocular surgery, including surgeries for glaucoma, [4][5][6] severe infectious keratitis, 7 cataract, 8,9 macular hole, 10 epiretinal membrane, 11 and rhegmatogenous retinal detachment. 12 Hemorrhage in the anterior chamber blocks the angle of the chamber, inhibiting aqueous drainage and resulting in an increase in intraocular pressure (IOP).…”

Commentary: Evaluation of complications and visual outcomes in various nucleus delivery techniques of manual small incision cataract surgery

“…The original article titled “Evaluation of complications and visual outcomes in various nucleus delivery techniques of manual small incision cataract surgery” in this issue fills this lacuna. [3]…”