Volume : VI, Issue : IX, September - 2017

ADVANCAED CATARACTS SAFE SURGICAL TECHNIQUES FOR SAFE OUT COME

Dr . G. Satyavathi, Dr. Poornima

Abstract :

 Introduction: Advanced cataracts like Morgagnian hyper mature, Shrunken or sclerotic and Cataracta Nigra require proper pre operative evaluation  which anticipates and avoides Intra Operative surprises. The aim of study is to minimise Intra Operative and thereby postoperative complications by adequate preoperative evaluation and to assess the effectiveness of various techniques rather than following standard surgical procedure. Selecting appropriate operative steps suitable to that particular type of cataract in its advanced stage protects cornea and posterior capsule  so that good visual out come, minimal recovery period, and  a better quality of life can be given . One must be familiar with various operative techniques of cataract surgery.   Sometimes advanced procedures like Phaco, MICS, SMILE may not be suitable especially in cases like Cataracta Nigra though the surgeon is familiar with. To achieve good visual outcome various modified techniques are applied.  Material and Methods: In this Prospective, hospital based study of 9 months from August 2016 to April 2017, 30 patients (30 eyes) aged 50 years or older  attending the General Ophthalmic department are included in the study group with another group of 30 patients (30eyes)  as controls.  The study is on age related cataracts in advanced stage which are basically. 1) Morgagnian hypermature cataract 2) Hyper mature Shrunken  cataract and 3) Cataracta Nigra.Technicques like Large Incision Nuclear Expression Cataract Surgery/ Small Incision Nuclear Expression Cataract Surgery, Continuous or discontinuous capsulotomy by means of cutting with Vanas scissors ,sphincterotomy for small and rigid pupil are applied whenever necessary in study group rather than only SICS in control group. Eyes with pseudoexfoliation having poor pupillary dilation are also included. Eyes having phacodonesis, congenital anomalies, congenital cataract, gross corneal and retinal pathologies,  glaucoma and other ocular co morbidities are excluded. Results:  In control group complications like iridodialysis(6.66%), hyphema (13.33%), oken nucleus(10%),vitreous presentation(16.66%) are observed. Post operatively there is  striate keratopathy(33.33%), severe inflammatory reaction(20%), hyphema(6.66%). 2(6.66%)eyes developed corneal endothelial decompensation for which keratoplasty advised .The final visual out come is satisfactory in 66.66% of cases only. In study group  major complication we have come across intra operatively  is posterior capsule rent in 1(3.33%) eye where we could able to implant AC IOL(3.33%) . Complications like mild striate keratopathy in 2(6.66%) eyes and mild to moderate inflammatory reaction in 4(13.33%)eyes managed well. The final visual out come even in eye having AC IOL is 6/9 – 6/6 with correction in all(100%) cases.

Conclusion:  Cataract in advanced stage can be prone for pre , intra and postoperative complications. Modern procedures like Phacoemulsification, manual SICS,and MICS may not give good results.One must be familiar with several techniues.

Keywords :

Article: Download PDF   DOI : 10.36106/ijsr  

Cite This Article:

Dr .G.Satyavathi, Dr.Poornima, ADVANCAED CATARACTS SAFE SURGICAL TECHNIQUES FOR SAFE OUT COME, INTERNATIONAL JOURNAL OF SCIENTIFIC RESEARCH : Volume-6 | Issue-9 | September-2017

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