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      Efficacy and safety of intraoperative intracameral mydriasis in manual small incision cataract surgery - A randomized controlled trial

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          The purpose of this study is to assess the efficacy and safety of intracameral mydriatic solution, as compared to preoperative topical mydriatics, in patients undergoing manual small incision cataract surgery (MSICS) under peribulbar anesthesia. To assess the sustainability of intracameral mydriasis in MSICS by monitoring pupil size at specific junctures during the surgery.


          This trial recruited 127 patients, who underwent MSICS under peribulbar block. Mydriasis in topical group was achieved with preoperative topical dilating drops while patients in intracameral group were taken up for surgery without dilation, and mydriasis was achieved intraoperatively with intracameral solution. Pupil sizes were measured serially, at six different junctures during surgery. Time duration of surgery, any intraoperative complications and first postoperative day visual acuity, corneal edema score, and anterior chamber inflammation score were noted in all patients.


          Mean pupil size just before peribulbar block was 7.3 mm in topical group and 3.3 mm in intracameral group ( P < 0.001). Mean pupil size in intracameral group increased to 7.3 mm 30 s after injecting intracameral dilating solution. Mean pupil size in both groups progressively reduced, reaching 5.5 mm (topical group) and 6.2 mm (intracameral group) just before intraocular lens implantation ( P = 0.001), and measured 5.1 mm and 5.5 mm, respectively, at the end of surgery ( P = 0.048). On first postoperative day, there was no significant difference in distribution of corneal edema scores, AC inflammation scores, and in median logMAR visual acuity between the two groups.


          MSICS can be performed effectively and safely utilizing intracameral mydriatic solution, without the use of preoperative dilating drops.

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          Most cited references 21

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          Visual acuity measurements.

           C Holladay (2004)
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            Cataract surgery for the developing world.

            To review surveys published within the last year concerning the prevalence of cataract blindness, rates of cataract surgical coverage and visual outcomes of cataract surgery in various developing countries, and to review recent studies that compare the different cataract surgical techniques used in developing countries. Up to 75% of blindness (visual acuity below 20/400) is due to cataract. Cataract remains the most common treatable cause of blindness. Reported cataract surgical coverage is low, and visual outcomes are poor and necessitate improvement. Phacoemulsification is the preferred technique for cataract surgery in developed countries, but large-scale implementation in developing countries may prove to be a challenge. An alternative surgical technique, manual sutureless small incision extracapsular cataract surgery, has been increasing in popularity, as the technique has been shown to yield similar surgical outcomes as phacoemulsification. Treating cataract blindness worldwide continues to be a formidable challenge. Significant barriers include cost, lack of population awareness, shortage of trained personnel and poor surgical outcomes. Both phacoemulsification and manual small incision extracapsular cataract surgery achieve excellent visual outcomes with low complication rates, but manual small incision extracapsular cataract surgery is significantly faster, less expensive and requires less technology. Therefore, manual small incision extracapsular cataract surgery may be the preferred technique for cataract surgery in the developing world.
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              Outcomes of high volume cataract surgeries in a developing country.

              To analyse the outcome of high volume cataract surgery in a developing country, community based, high volume eye hospital. In a non-comparative interventional case series, the authors reviewed the surgical outcomes of 593 patients with cataract operated upon by three high volume surgeons on six randomly selected days. There were 318 female (54%) and 275 male (46%) patients. Their mean age was 59.57 (SD 10.13) years. The majority of the patients underwent manual small incision cataract surgery (manual SICS). Extracapsular cataract extraction with posterior chamber intraocular lens (ECCE-PCIOL) and intracapsular cataract extraction (ICCE) were also done on a few patients as clinically indicated. Best corrected visual acuity of >or=6/18 was achieved in 94% of the 520 patients who could be followed up on the 40th postoperative day (88% follow up rate). Intraoperative and immediate postoperative complications as defined by OCTET occurred in 11 (1.9%) and 75 (12.6%) patients, respectively. Average surgical time of 3.75 minutes per case (16-18 cases per hour) was achieved. Statistically significant risk factors for outcomes were found to be age >60, sex, and surgeon. High volume surgery using appropriate techniques and standardised protocols does not compromise quality of outcomes.

                Author and article information

                Indian J Ophthalmol
                Indian J Ophthalmol
                Indian Journal of Ophthalmology
                Medknow Publications & Media Pvt Ltd (India )
                July 2017
                : 65
                : 7
                : 584-588
                Department of Ophthalmology, P. E. S. Institute of Medical Sciences and Research, Kuppam, Andhra Pradesh, India
                [1 ]Department of Ophthalmology, Ramaiah Medical College, Bengaluru, Karnataka, India
                [2 ]Department of Ophthalmology, Bangalore Medical College and Research Institute, Bengaluru, Karnataka, India
                Author notes
                Correspondence to: Dr. K Ajay, 233, 18th Main Road, 6 th Block, Koramangala, Bengaluru - 560095, Karnataka, India. E-mail: drajayk@ 123456gmail.com
                Copyright: © 2017 Indian Journal of Ophthalmology

                This is an open access article distributed under the terms of the Creative Commons Attribution-NonCommercial-ShareAlike 3.0 License, which allows others to remix, tweak, and build upon the work non-commercially, as long as the author is credited and the new creations are licensed under the identical terms.

                Original Article

                Ophthalmology & Optometry

                intracameral, manual small incision cataract surgery, mydriasis


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