Is Manual Small Incision Cataract Surgery the Preferred Technique for Hard Cataract?

Cataract extraction is the most commonly performed surgery in Ophthalmology worldwide. Endothelial cell loss, of variable degree, is an inevitable consequence following cataract surgery. Many preoperative and intraoperative factors decide the outcome; surgical techniques have also been proven to dictate the postoperative endothelial cell loss. It is hence of paramount importance to ascertain the safest procedure. It has been established that no technique leaves the endothelium unscathed and it is indisputable that the amount of energy used in phacoemulsification is directly proportional to the hardness of the cataract. Issues that contribute to final outcome and are poorly addressed by a technique make it the poorer choice. This article reviews the currently available literature analyzing different factors that influence endothelial cell loss.