Determinants Of Visual Outcomes After Small Incision Cataract Surgery In Patients With No Ocular Morbidity.

DETERMINANTS OF VISUAL OUTCOMES AFTER SMALL INCISION CATARACT SURGERY IN PATIENTS WITH NO OCULAR MORBIDITY.

Authors :Presenting author- Dr. Kumud JeswaniCo authors: Dr Kuldeep Dole Dr Shruti Shah Dr. Nilesh Kakade.PMBA ‘S H .V . Desai Eye Hospital, PUNE.

Purpose

To Assess the best-corrected visual acuity (BCVA) at 6 weeks after small incision cataract surgery (SICS) and review the various determinants affecting the final visual outcome.

Methods

• Retrospective analysis of 503 patients who underwent uneventful small incision cataract surgery over one year between 2015 to 2016 was done.

• The pre -operative ,operative ,postoperative details were documented.

• We identified the factors affecting the final visual acuity at one week and 6 week follow up periods

Results

60

443

503

with co ormidities 11.9% without co morbidi-ties 88.07%

443 of 503 patients were included in the study excluding ones with co morbidities affecting final visual outcome

176

267

443

vision less 6/18 -39.72%more than 6/18-60.27%

176 (39.73%) of 443 had visual acuity <6/18 and 267(60.27%) of 443 had visual acuity better than >6/18.

• Further analysis of the factors affecting vision in low visual acuity group was done.

These were –• Surgeon related• Biometry• Grade of cataract • Post operative astigmatism

cons

ultan

ts

fellow

s

medica

l offic

ers

reside

nts0

20406080

100120 103

1532 25

operating surgeons

operating surgeons

It was found that the group of patients operated by consultants had a greater likelihood of better visual outcome as in comparison to other groups

immatu

re

mature

hype

rmatu

rebro

wn0

20406080

100120140 123

40

3 10

grades of cataract

grades of cataract

The visual outcome in the immature group was found to better than other groups indicating a better pre operative vision gives a good post operative visual prognosis.

more than 1 less than 170

75

80

85

90

95

spherical equivalent

spherical equiva-lent

81 patients of 176 had spherical equivalent of more 1And 95 eyes of patients had spherical equivalent of less than 1 .

cylinder more than 1

cylinder less than 1

020406080

100120

176

176

BCVA of patients after 6 weeks showed cylinder of more than -1 in 110 patients of 176 indicating 62.50 percent had astigmatism.

Conclusion• The major culprits for poor visual rehabilitation post small incision cataract surgery are biometric calculations and astigmatism.

• The astigmatism is induced surgically or if was pre existing needs a further analysis.

• The surgically induced astigmatism needs to be controlled by proper analysis of keratometry values pre operatively, planning incision size , Incision position , capsulorhexis size, using intraoperative keratometers etc.

• Immersion scans , vision x can be done in all patients to decide the accurate axial length and updating of IOL formulae can be attempted.

Additional studies including larger sample size with documentation of the variables preoperatively affecting astigmatism needs to be employed.

In era of phacoemulsification. small incision cataract surgery can be made cost effective and also at the same time have the best possible visual outcome.

THANK YOU.