Vinodhini Kannan, Radhakrishnan Balasubramaniam, Thangerani Raajaseharan, Nazeem Farzana Ghouse
BACKGROUND Manual Small Incision Cataract Surgery (MSICS) is a well-known technique of cataract surgery owing to its advantage of a self- sealing suture less incision with least surgically induced astigmatism at a low cost. It is a safe, simple, consistent, stable and cost-effective technique with various modifications that involve site, size, type of incision and method of nucleus delivery. One such modification is Temporal Incision MSICS, where the cataract surgery is done by a temporal approach, which is equally good compared to the superior incision. This study was done retrospectively to analyse the visual outcome of patients operated by Manual SICS - Temporal Approach, using the WHO criteria and to establish its efficacy as a good surgical technique. MATERIALS AND METHODS Records of patients operated for senile cataract by a single surgeon by Temporal MSICS using a temporal sclerocorneal incision of 6-6.5 mm, during a 1-year period, were analysed retrospectively. Post-operative followup records of POD-1 and subsequent follow-ups at 1st week and 6th week were recorded for visual outcome. RESULTS Out of the 83 cases analysed retrospectively, majority of them were found to be between 61-70 years with a female Preponderance. Most of the cases were found to have senile immature cataract (55 patients), with Grade III nuclear sclerosis (52 cases). The pre-operative visual acuity was poor <6/60 in 72 cases (86.7%) and borderline in 11 cases (14.5%). 55 cases (66.3%) had a 6.5 mm scleral incision and the remaining 28 cases (33.7%) had a 6 mm incision. Average duration of surgery noted was 8.35 minutes. Striate Keratopathy was the most common 1st POD complication followed by corneal oedema. Striate keratopathy was the most common complication at the 1st week followup followed by pigment dispersion. Majority of cases (76 cases) were found to have been complication free at the end of 6 weeks. At the end of 6 weeks post-operatively as per records, 80 cases (96.4%) had good BCVA and only 3 (3.6%) cases had borderline vision and none had < 6/60 vision, which fulfilled the WHO criteria of 90% BCVA post-op with <5% poor vision. Here the 80% threshold was found to have been attained in the 1st post-op week itself, based on our observations. Difference between pre-op and post-op Keratometry values were minimal, also the distribution of types of astigmatism appeared similar to that of pre-op astigmatism. CONCLUSION In this study it was found that the temporal approach MSICS fulfilled the WHO criteria for good surgical technique, and it is a safe and reliable method and is complementary and equally effective to other standardised techniques and approaches, with less complications and early visual rehabilitation.
