Astigmatic Change in Manual Small Incision Cataract Surgery (MSICS) with Chevron Type of Incision

Authors : Dr.Sujit Kumar Biswas; Dr. Quamrul Islam; Dr. Rajib Husain; Dr. Suborna Sultana; Dr. Nahid Anjum

Volume/Issue : Volume 7 - 2022, Issue 4 - April

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To evaluate the astigmatic change after Manual Small Incision Cataract Surgery with chevron type of incision. Design: A prospective interventional study. Materials & Methods: A total 100 cases were selected who underwent manual small incision cataract surgery with chevron incision for that one year period irrespective of gender. This study was done in cataract clinic at Chittagong Eye Infirmary and Training Complex. Related all pre- and postoperative data were recorded according to the protocol of the hospital. All surgeries were done under peribulbar anesthesia. A ā€œVā€ shaped chevron partial thickness sclera incision was done on the superior quadrant of every patient by a keratome. Pocket tunnel is dissected with a crescent knife. All other steps of were done like standard small incision cataract surgery. All intraocular lenses (IOLs) were implanted in capsular bag. Post operatively patients were treated with topical corticosteroid six times daily approximately four weeks then tapered, topical antibiotic four times daily for one week and topical cycloplegic once daily for two weeks. All patients were followed up on 1st postoperative day, 7th postoperative day and after one month. Results: Mean ages of these patients were 59.66 Ā± 10.81 years (ranged 30-70 years). Here we found that Chevron Incision is relatively more stable in ATR astigmatism group than WTR astigmatism (63.04% and 72.71% respectively). But in NO astigmatism group it gives opposite results, that that was changed to WTR astigmatism more than ATR astigmatism (60% and 40% respectively). A significant change occurred between pre- and post-operative astigmatism in different groups (p-0.001). Sixty nine percent (69%) gain Complete success i.e, incision induced astigmatism was up to 0.50 D, 27% were in Qualified success and only 4% were failed. Post operative final visual outcome of this study group is excellent, 98% achieved BCVS equal or better than 6/18. No patient showed significant post operative complication. Tunnel construction was the most difficult step in this type of incision through the sclera. Conclusion: This prospective study showed chevron incision causes a significant change in astigmatism postoperatively. Although magnitude of surgically induced astigmatism was significant, outcome of chevron incision in term of final postoperative vision is excellent. Tunnel construction was somewhat difficult. We have to compare with other type of incision to assess the efficacy of Chevron incision.

Keywords : Chevron incision, manual small incision cataract surgery (MSICS), with the rule astigmatism (WTR), against the rue astigmatism (ATR).


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