This study compares the changes in central corneal thickness and post op visual outcome between phacoemulsification and manual small incision cataract surgery in Indian eyes with pseudoexfoliation syndrome with grade II and III nuclear cataracts: A single surgeon series

Abstract

Abstract Purpose of the study To compare post op alteration of central corneal thickness (CCT) and visual outcome between phacoemulsification (group A) and manual small incision cataract surgery (MSICS) (group B) in grade II & III nuclear cataracts (NS II & III) with pseudoexfoliation syndrome (PXF). Setting Ruby Eye Hospital, Berhampur. Type of study Double masked prospective randomized interventional study. Grouping Group A: Phacoemulsification arm. Group B: Manual Small Incision Cataract surgery arm. Materials and methods A total of 60 eyes of 60 patients were assigned randomly to either phacoemulsification (group A) or MSICS (group B). All eyes had nuclear sclerosis grade II and III (LOCS II grading system) with pseudoexfolation material either over pupillary margin or anterior lens capsule or both. All surgeries were done by a single surgeon. Post operative evaluation was scheduled at 1st, 30th, 90th and 180th day post op. Statistical analysis was done using appropriate formulae. Main outcome measures Changes in CCT, visual acuity (uncorrected [UDVA] and corrected [CDVA]) and spherical equivalent in the operated eye up to 6\u202fmonths post op. Results Mean pre operative CCT showed no difference between the groups (0.9659). Mean rise in CCT 1st post op day (POD) showed significant difference between the groups {24.65 (SD 9.32) [group A (Phacoemulsification)] and 33.34 (SD11.68) [group B (MSICS)] (p 0.0023)}, but at 1st, 3rd and 6th month POD there was no significant difference. Mean uncorrected distance visual acuity (UDVA) 1st POD was 0.189 (SD 0.118) in Group A and 0.302 (SD 0.121) in group B (p 0.0005) significantly better with phacoemulsification procedure and at 1st month was 0.039 (SD 0.084) in group A and 0.148 (SD 0.089) in group B (p 0.004) which remained almost stable thereafter. Mean corrected distance visual acuity (CDVA) at 1st, 3rd and 6th month POD showed no significant difference (p 0.8). Mean spherical equivalent was 0.29 in group A and 0.8 in group B. Conclusion In moderately hard nuclear cataracts with PXF, phacoemulsification provides better unaided visual outcome with lesser endothelial dysfunction than MSICS in immediate and late post op.