Changes in Corneal Endothelial Cells Following MSICS VERSUS Conventional ECCE in a Tertiary Eye Hospital in North Western Nigeria

Abstract

Background: This study was undertaken to compare the effect of two surgical techniques of cataract extraction on corneal endothelial cell density in eyes of Nigerian adults with uncomplicated age-related cataract with the view to improving surgical visual function and quality of life. Materials and Methods: It was a prospective randomized non blinded hospital based interventional study. Two hundred and seventy-seven (277) eyes of 269 eligible patients with cataract were randomized to either manual small incision cataract surgery (MSICS) or conventional extracapsular cataract extraction (ECCE). The endothelial cell density (ECD), Coefficient of variation (CV), and Hexagonality (%) were measured pre-operatively, at one, four and twelve weeks post-operatively with a non-contact specular microscope (CSO SP 02). Statistical analysis – Data obtained were entered into microsoft Excel and analyzed using SPSS version 16 software. Result: Of the 277 eyes studied, 263 (94.9%) were analysed. The mean age of patients for MSICS and ECCE was 64.03 (SD + 11.2, range 40 – 95 years) and 62.69 (SD +10.48, range 42 – 94 years) respectively. The Male to female ratio was 1.9:1, in the two study groups. Pre-operatively, corneal parameters (mean ECD, CV and hexagonal cells) were similar between the two surgery groups. Postoperatively cataract surgery induced a mean endothelial cell density loss of 5.31% at one week, 7.28% at 4 weeks and 7.06% at 12 weeks in the study population. There was no statistically significant difference in the mean endothelial cell density loss between MSICS and ECCE groups. Conclusion: Both MSICS and ECCE induced fairly equal moderate and reversible degree of endothelial cell density loss in adults with uncomplicated age related cataract. Keywords; Endothelial cell density, ECCE, MSICS, Uncomplicated Cataract. Department of 1Ophthalmology, Federal Teaching Hospital, Gombe, 2Vitreoretina Department, National Eye Centre, Kaduna, 3Noor Dubai Foundation, Dubai, UAE, 4Department of Ophthalmology, Ahmadu Bello University Teaching Hospital, Zaria. Corresponding Author Dr Saudatu Umar Madaki, Department of Ophthalmology, Federal Teaching Hospital, Gombe P M B 0037 Email addresssaudeumarmadaki@yahoo.com Introduction Cataract is a major cause of blindness worldwide and cataract surgery is the most frequently performed ophthalmic surgery1.In recent decades, ophthalmologists performing cataract surgery have witnessed the successful application of new technology that have increased the efficiency of surgical technique, advanced standard of care and most importantly, given rise to better patient outcomes2.Surgical techniques have evolved in the last few decades from intracapsular cataract extraction through extracapsular cataract extraction, MSICS, Access this article online