Comparison of small incision cataract surgery with conventional extra capsular cataract surgery: an evaluation from resource poor setting in India

Rubii Malhotra, Pragati Garg, Luxmi Singh, Simmi Chawla

Abstract

Background: Cataract is the chief cause of avoidable blindness in the developing countries of the world including India. These patients can regain normal sight with the help of cataract surgery, which has undergone many advances and Small Incision Cataract Surgery (SICS) has gained wide acceptance world over as the surgical method requires minimal infrastructure. The present study compares it’s safety profile for the patients as well as acceptability amongst the doctors performing conventional Extra Capsular Cataract Extraction (ECCE) surgery in peripheral resource poor settings.

Methods: All patients having cataract were examined prior to surgery and were randomized in two groups: group I - small incision cataract surgery and group II - conventional extra capsular cataract extraction surgery with posterior capsular intra ocular lens implantation. The various intra and post-operative complications were evaluated.

Results: 252 eyes of 252 patients were enrolled with 121 patients in group I and 131 patients in group II and intra-operative and post-operative complications compared. Intra-operatively difficulty in nucleus delivery was higher in group I (12.3%) whereas repeated iris protrusion (12.5%) and posterior capsular rent (8.3%) was higher in group II. Postoperatively, on day 1 striate keratopathy was commoner in group I (20.6%) whereas uveitis was seen more commonly (26.7%) in group II. At 6 weeks, surgically induced astigmatism was higher (61%) in group II as compared to group I (35%).

Conclusion: SICS is a safe and acceptable alternative to conventional ECCE in a peripheral teaching setup.

Keywords

Cataract, Complication, Intraoperative, Post-operative, Small incision

Full Text:

PDF

References

Thylefors B, Negrel AD, Pararajasegram R, et al. Global data on blindness. Bull World Health Organ. 1996;74:319-24.

Dandona L, Dandona R, Naduvilath T, et al. Is current eye care policy focus almost exclusively on cataract adequate to deal in India? Lancet. 1998;351:1312-6.

Minnassian DC, Mehra V. 3.8 million blinded by cataract each year; projections from the first epidemiological study of incidence of cataract blindness in India. Br J Ophthalmol. 1990;74:341-3.

Gogate PM. Small incision cataract surgery: complications and mini review. Indian J Ophthalmol. 2009;57:45-9.

Blumenthal N. Small incision method of extra capsular cataract extraction using selective hydrodissection. Ophthal Surg. 1992;23(10):699-701.

Mackool RJ, Holtz SJ. Descemet’s membrane detachment. Arch Ophthalmol. 1977;94:459-63.

Gogate PM, Deshpande M, Wosmald RP, et al. ECCE compared with manual SICS in community Eye care setting in western India. A randomized control trial. Br J Ophthalmol. 2003;87:667-72.

Das H, Das BP, Panda A. Pattern of intra ocular pressure changes following manual small incision cataract surgery. Kathmandu Univ Med J (KUMJ). 2005 Oct-Dec;3(12):340-4.

Ruite S, Tabin GC, Nissman, et al. Low cost, high volume ECCE with PC IOL implantation. Ophthalmol. 1999;106:1887-992.

Gogate PM, Deshpande M, Wormald RP, et al. Extra capsular cataract surgery compared with Manual small incision cataract surgery in community eye care setting in Western India: a randomized controlled trial. Br J Ophthalmol. 2003;87:667-72.

Minassian DC, Rosen P, Dart JKG, et al. Extracapsular cataract extraction compared with small incision surgery by phacoemulsification: a randomized trial. Br J Ophthalmol. 2001;85;822-9.

Ruit S, Tabin G, Chang D, et al. A prospective randomized clinical trial of phacoemulsification vs. manual sutureless small incision extra capsular cataract surgery in Nepal. Am J Ophthalmol. 2007;143:32-8.

Venkatesh R, Das M, Prasanth S, et al. Manual small incision cataract surgery in eyes with white cataracts. Indian J Ophthalmol. 2005;53:173-6.

Gogate PM, Deshpande, Wormald RP. Is manual small incision cataract surgery affordable in the developing countries? A cost comparison with extra capsular cataract extraction. Br J Ophthalmol. 2003;87:843-6.