Long-Term Visual Outcome in Surgical Management of Cataract Coexistent With Corneal Opacity in One-Eyed Patients

Outcomes of manual small incision cataract surgery (MSICS) in eyes with corneal opacity

PURPOSE

To report the outcomes of manual small incision cataract surgery (MSICS) in eyes with corneal opacity.

SETTING

Tertiary care ophthalmic hospital.

DESIGN

Retrospective study.

METHODS

This retrospective study included 286 eyes of 286 patients having cataract with a pre-existing corneal opacity who underwent manual small incision cataract surgery (MSICS) at a tertiary eye institute between January 2020 and January 2022. Data were retrieved from electronic medical records, and we documented demographics, history, detailed anterior and posterior segment examination, cataract grading, pre- and post-operative vision, intra-operative complications and its management, and post-operative course. All these parameters were recorded at the baseline visit, day 1 and at 1 month post-operatively.

RESULTS

Two hundred eighty-six eyes having cataract with a pre-existing corneal opacity which underwent MSICS were evaluated. Corneal opacity was graded as nebular, nebulo-macular, macular and leucomatous types; nebular opacity being the most common. Trauma was the most common cause of opacity followed by infective keratitis. Intra-operative complication rate was 4.89%; which included-7 posterior capsular rent with vitreous disturbance, 2 zonular dialysis, 2 iridodialysis, 2 eyes with aphakia and 1 with Descemet membrane detachment. On follow-up, 6 patients had decentered intraocular lens and 10 had residual cortex. Median logMAR vision improved significantly (p < 0.001) from 1.08 (5/60) pre-operatively to 0.3 (6/12) post-operatively.

CONCLUSION

MSCIS is efficient in providing favorable visual outcomes in patients where corneal opacity makes it difficult for the surgeon to perform a phacoemulsification surgery.

Phacoemulsification in patients with corneal opacities using slit illumination of the surgical microscope

ABSTRACT

Performing phacoemulsification (PE) in eyes with corneal opacities is challenging even with expert surgeons. Several techniques have been described to improve intraoperative visualization through opacified corneas. This retrospective interventional case series included 10 eyes of 10 patients with coexisting senile cataract and corneal opacity who underwent PE with intraocular lens (IOL) implantation under slit illumination of the surgical microscope. Uneventful PE with IOL implantation was achieved in all eyes without intraoperative complications. Slit illumination reduces the light scattering and reflection from the corneal opacity, enhances the red reflex, and improves depth perception simultaneously in different steps of PE. Phacoemulsification can be safely performed in eyes with corneal opacity under slit illumination of the surgical microscope. It can be considered as a viable option for improving intraoperative visualization in patients with corneal opacities without additional instrumentation.