Nazullah, Kashif Kamran, Tariq Farooq Babar.
Comparison of Surgically Induced Astigmatism in Manual Small Incision Cataract Surgery & Phacoemulsification Surgery.
Ophthalmol Update Jan ;14(1):21-6.

Objective: Conventional Extracapsular cataract surgery (ECCE), Manual small incision cataract surgery (MSICS), and Phacoemulsification are the three popular forms of cataract surgery in Pakistan. Common complications such as surgically induced astigmatism, hyphema and striate keratopathy are important causes of poor uncorrected visual acuity after cataract surgery and by knowing how to minimize it we can improve visual outcome of cataract surgery. Surgically induced astigmatism (SIA) is still a common obstacle for achieving excellent uncorrected visual acuity. In this study it was meant to find out that if postoperative astigmatism in MSICS and Phacoemulsification techniques is comparable than we can encourage our trainees to do MSICS because most of trainees have to serve in periphery in their early carrier where Phacoemulsification equipment is not available. To compare mean surgically induced astigmatism in Manual Small Incision Cataract Surgery and Phacoemulsification surgery. Materials & Methods: This was a randomized control trial. 214 patients were included in our study through our Out Patient Department (OPD) from 30th May 2014 till 30th December 2014 in Khyber Institute of Ophthalmic Medical Sciences (KIOMS), Hayatabad Medical Complex, Peshawar. Informed written consent was taken from every patient. Personal bio-data was recorded on predesigned proforma. First, patients were randomly allocated to a group by lottery method and subsequent patients were alternatively allocated to other group by consecutive sampling into Phacoemulsification surgery group and manual small incision cataract surgery group. Corneal astigmatism was measured by Helmholtz keratometer (Topcon OM4) (k values were taken in diopter). All patients were operated by two experienced using manual small incision cataract surgery technique and Phacoemulsification. Corneal astigmatism was measured pre-operatively then at 6th week post operatively in both groups with the same keratometer. Using pre-op and 6 weeks keratometric astigmatism readings, SIA was calculated by subtraction method. Axis of astigmatism was determined by comparing K readings in diopters. K1 > K2 means with-the-rule astigmatism, K2 > K1 means against-the-rule astigmatism, while K1 = K2 means neutral astigmatism. Results: Mean age for Phacoemulsification surgery group was 61.8�4 yrs and 60.7�3.5 yrs for MSICS group. More patients were present in age group 56-60 yrs for both groups. Pre-operative mean astigmatism was 0.5240, 0.5440 for Phacoemulsification group and MSICS group respectively. Post-operative mean astigmatism was 0.792, 0.8242 for Phacoemulsification group and MSICS group respectively. P value for these astigmatism was 0.8058, 0.6922 for pre-operative and post-operative mean astigmatism respectively. Surgically induced mean astigmatism was 1.1 D�0.9 D, 1.2�0.8D for Phacoemulsification surgery group and MSICS group respectively, P=0.393, which was statistically not significant hence there was no difference in these two surgery groups. Conclusion: Manual small-incision cataract surgery is comparable to Phacoemulsification for the rehabilitation of the patient with cataract at 6 weeks. Manual small-incision cataract surgery is safe and nearly as effective. Small-incision surgery does not need the capital investment and recurring expenditure of a Phacoemulsification machine. So if we encourage our trainees to take interest in MSICS, so that their patients can enjoy early visual rehabilitation at low cost.

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