A study of factors affecting visual outcome in small incision cataract surgery

Introduction: In spite of the changing patterns of blindness seen globally, cataract remains the most common cause of blindness worldwide. Modern cataract surgery aims to achieve a better unaided visual acuity (VA) with rapid postsurgical recovery and minimal complications. Small incision cataract surgery (SICS) is the most common cataract surgery done all over the world due to its nondependence on expensive machines and easier learning curve. VA following surgery is one of the key indicators for evaluating the quality of surgery. Materials and Methods: This descriptive observational study was conducted in the ophthalmology department of a tertiary care hospital. It included 50 eyes of patients with uncomplicated senile cataract who underwent SICS. Patients were first evaluated for cataract using visual assessment, slit-lamp examination, ophthalmoscopy, and B-scan in case of mature cataracts. Results: Age of patients varied from 39 to 72 years. The hardness of the nucleus varied from Grade 1 to Grade 4 by lens opacities classification system III classification. The types of cataract operated were cortical cataract with posterior subcapsular cataract (n = 36) and nuclear cataract (n = 16). Thirty-eight eyes out of 50 eyes (68%) had unaided VA of 6/18–6/60, whereas only 24% of eyes had vision better than 6/18 on POD 1. Unaided visual outcome on POD 7 showed 60% cases with VA better than 6/18. In two cases, vision remained below 6/60. Intraocular lens power was determined using the SRK II formula. In majority of cases (48%), the incision size was between 6.5 and 7 mm. The contour of the external incision was straight in 72% cases and frown shape in 14% cases. Most eyes showed improvement of vision between 1st and 7th postoperative day. However, in one eye, vision remained below 6/60. Conclusions: Sight restoring cataract surgery is undoubtedly one of society's most cost-effective medical commonly done surgeries not only in India but also all over the world. All grades of nuclear sclerosis can be dealt with by this technique. A surgeon can further improve his/her postoperative results by giving due attention to the site, size, and contour of his/her incisions and taking care to protect the corneal endothelium while doing intraocular maneuvers and nucleus removal.