INTERNATIONAL JOURNAL OF SPECIAL EDUCATION Vol.37, No.

3, 2022

Evaluation of post operative visual outcome in small incision and

phacoemulsification cataract surgeries
Ragni Kumari1, Mrinal Ranjan Srivasatava2, Vibha Kumari3*, Sunil Kumar Gupta 4,
Pratik Sharma5 Luxmi Singh6, Pragti Garg7, Rajiv Janardhanan8

1. Ph. D. Scholar, Amity Institute of Public Health, Amity University, Noida India
2. Assistant Professor, Department of Community Medicine, Dumka Medical College,
Dumka India.
3. Assistant Professor, Department of Paramedical Sciences, Jamia Hamdard New Delhi
India
4. Assistant Professor, Department of Optometry, Era University, Lucknow
5. Tutor, Department of Optometry, Era University, Lucknow
6. Professor, Department of Ophthalmology, Era University Lucknow
7. Professor, AIIMS, Raebareli, Uttar Pradesh
8. Dean, Faculty of medical and health sciences, SRM IST, Chennai

Abstract

Background: Modern cataract surgeries are very safe and effective. They are performed with
the intraocular lenses. One of the most popular techniques used in developing countries is
small incisional cataract surgery. Phacoemulsification and manual small-incision cataract
surgery (MSICS) are the most commonly done procedures. Phacoemulsification is considered
the gold-standard procedure for cataract. However, MSICS has emerged as a popular
procedure of choice in the surgical treatment of cataracts as it is less expensive and is as
effective as phacoemulsification. The objective of the study is to evaluate of post -operative
visual outcome in small incision and phacoemulsification cataract surgeries. Methods:
prospective observational study was carried out in the Department of Ophthalmology at Era
University, Lucknow to evaluate the visual outcome in patients undergoing cataract surgery
by two different methods. Total 3372 patients were enrolled through convenience sampling
and were divided into two groups according to the surgery they had undergone. Group A-
1776 eyes undergone phacoemulsification and group B-1596 eyes operated by SICS method.
Results: Among 3372 participants 1776 went for phacoemulsification, out of them 863
(61.0%) got good visual outcome and 913 (39.0%) got poor visual outcome. 1596 patients
underwent SICS, out of them only 522 (34.6%) got good outcome and 1044 (53.3%) got poor
visual outcome. Conclusion: Phacoemulsification technique has the advantage of early visual
rehabilitation after cataract surgery and this is mainly attributed to the small incision size
used

Key words: Phacoemulsification, small incision, Outcome, Surgeries

Introduction

An eye is a spherical structure that consists of three layers: the outer part, the middle section,
and the iris. Behind the lens are the ciliary body and the nervous tissue layer retina. In the

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world, around 45 million people are blind and around 17.6 million are suffering from
cataract.1 In India, around 20 lakh new cases are being added each year. Modern cataract
surgeries are very safe and effective. They are performed with the intraocular lenses. One of
the most popular techniques used in developing countries is small incisional cataract surgery.
This procedure is commonly used for high-volume cataract surgery. It provides a good visual
outcome and is less prone to complications. Conjunctival congestion lasts for about 5 to 7
days after cataract surgery.2 It is caused by the size of the incision, which is usually larger
than the PHACO or microsurgical instrument. The procedure, which was first performed in
1967, is a combination of the chop method and the PHACO system. It's a safer, more
effective method for minimizing bruising and improving the wound's stability. The procedure
known as PHACO is not a practical option for treating hard cataracts due to its high risks of
corneal damage and nuclear drop complications.3 In 2016, around 65.2 million people
worldwide have cataracts. In Indonesia, it has been estimated that over a million individuals
have visual impairment due to cataracts. The prevalence of the condition in the country has
increased due to its tropical climate. Manual SICS is a commonly performed procedure for
cataract patients who are not able to perform phacoemulsification due to unfavorable
conditions. It is also less time-consuming and requires less maintenance. However, it has the
same visual outcome as phacoemulsification4. The objective of the study is to evaluate of
post -operative visual outcome in small incision and phacoemulsification cataract surgeries

Material and method

This prospective observational study was carried out in the Department of Ophthalmology at
Era University, Lucknow to evaluate the visual outcome in patients undergoing cataract
surgery by two different methods. Total 3372 patients were enrolled through convenience
sampling in this study after fulfilling the inclusion and exclusion criteria and were divided
into two groups according to the surgery they had undergone. Group A-1776 eyes undergone
phacoemulsification and group B-1596 eyes operated by SICS method. Study protocol was
approved by Institutional Review Board. Written informed consent was obtained from all the
patients or patient’s relative. Patients with systemic diseases like diabetes (DM), hypertension
(HTN), with posterior segment pathology, ARMD, retinal vascular diseases and patients with
Glaucoma, history of trauma, uveitis and corneal opacity were excluded from the study.

Result

Section I Demographic characteristics in relations to surgeries performed

Table 1: Gender distribution of cases

SI Asymptotic
GENDER Total Significance (2-
Phacoemulsification SICS
sided)
858 800 1658
Female
51.7% 48.3% 100.0% 0.301
918 796 1714
Male
53.6% 46.4% 100.0%
Total 1776 1596 3372

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52.7% 47.3% 100.0%

A total of 3372 cases were included in the study. Amongst the 3372 cases, 1714 were male;
out of which 918 had undergone phacoemulsification and 796-SICS. 1658 cases were
female; out of which 858 had undergone phacoemulsification and 800 had SICS. The
calculated value is not significant

Table 2: Age distribution

SI Asymptotic
Total Significance
AGE Phacoemulsification SICS
(2-sided)
1057 941 1998
50-60
52.9% 47.1% 100.0%
515 507 1022
61-70
50.4% 49.6% 100.0%
190 140 330 0.093
71-80
57.6% 42.4% 100.0%
14 8 22
81-90
63.6% 36.4% 100.0%
1776 1596 3372
Total
52.7% 47.3% 100.0%
Amongst the 1998 cases of the age group of 50-60, 1057 had done Phacoemulsification and
941 had done SICS. Amongst 1022 cases in the age group of 61-70, 515 had done
Phacoemulsification and 507 had done SICS. Amongst 330 cases in the age group of 71-80,
190 had done Phacoemulsification and 140 had done SICS. Amongst 22 cases in the age
group of 81-90, 14 had done Phacoemulsification and 8 had done SICS It is statistically not
significant.

Table 3: Distribution of patients in occupation

SI Asymptotic
OCCUPATION Total Significance
Phacoemulsification SICS
(2-sided)
215 0.000 357
Computer operator
60.2% 39.8% 100.0%
453 574 1027
Farmer
44.1% 55.9% 100.0%
183 30 213 0.000
Housework
85.9% 14.1% 100.0%
628 650 1278
Housewife
49.1% 50.9% 100.0%
Labor 20 58 78

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25.6% 74.4% 100.0%

59 70 129
Retired
45.7% 54.3% 100.0%
218 72 290
Teacher
75.2% 24.8% 100.0%
1776 1596 3372
Total
52.7% 47.3% 100.0%

As per occupation 357 were computer operator and all had done Phacoemulsification. 1027
were farmers where 453 had done Phacoemulsification and 574 had done SICS. 213 were
doing housework where 183 had done Phacoemulsification and 30 had done SICS. 1278 were
housewife where 628 had done Phacoemulsification and 6500 had done SICS. 78 were
laborers where 20 had done Phacoemulsification and 58 had done SICS. 129 were retired
where 59 had done Phacoemulsification and 70 had done SICS. 290 were teachers where 218
had done Phacoemulsification and 72 had done SICS. It is statistically significant

Table 4: Distribution of patients in family structure

SI Asymptotic
Family Structure Total Significance
Phacoemulsification SICS
(2-sided)
1180 932 2112
Joint Family
55.9% 44.1% 100.0%
80 200 280
Nuclear Family
28.6% 71.4% 100.0%
0.000
516 464 980
Single
52.7% 47.3% 100.0%
1776 1596 3372
Total
52.7% 47.3% 100.0%
As per family structure 2112 were from joint families where 1180 had done
Phacoemulsification and 932 had done SICS. 280 were from nuclear families where 80 had
done Phacoemulsification and 200 had done SICS. 980 were from joint families where 516
had done Phacoemulsification and 464 had done SICS. It is statistically significant

Table 5: Distribution of patients in personal habit

SI Asymptotic
PERSONAL HABIT Total Significance
Phacoemulsification SICS
(2-sided)
135 78 213
Alcoholic
63.4% 36.6% 100.0%
1079 939 2018
NA
53.5% 46.5% 100.0%

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420 206 626 0.000

Smoking
67.1% 32.9% 100.0%
142 373 515
Tobacco
27.6% 72.4% 100.0%
1776 1596 3372
Total
52.7% 47.3% 100.0%
According to personal habits 213 were alcoholic and out of that 135 had done
Phacoemulsification and 78 had done SICS. 2018 were not having any habit and out of that
1079 had done Phacoemulsification and 939 had done SICS. 626 were smokers and out of
that 420 had done Phacoemulsification and 206 had done SICS. 515 were using tobacco and
out of that 142 had done Phacoemulsification and 373 had done SICS. It is statistically
significant

Table 6: Distribution of patients in Education

Surgical Intervention Asymptotic

EDUCATION Total Significance
Phacoemulsification SICS (2-sided)

172 88 260
Graduate
66.2% 33.8% 100.0%

534 616 1150

Illiterate
46.4% 53.6% 100.0%

32 86 118
Intermediate
27.1% 72.9% 100.0%
0.000
198 146 344
Postgraduate
57.6% 42.4% 100.0%

840 660 1500

Primary
56.0% 44.0% 100.0%

1776 1596 3372

Total
52.7% 47.3% 100.0%

According to education 260 were graduates and out of that 172 had done Phacoemulsification
and 373 had done SICS. 1150 were illiterate and out of that 534 had done
Phacoemulsification and 616 had done SICS. 118 were intermediate and out of that 32 had
done Phacoemulsification and 86 had done SICS. 344 were Postgraduates and out of that 198
had done Phacoemulsification and 146 had done SICS.1500 were having primary education

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and out of that 840 had done Phacoemulsification and 660 had done SICS. It is statistically
significant

Table 7: Distribution of patients in Socio-economic status

Surgical Intervention Asymptotic

Socio-economic status Total Significance
Phacoemulsification SICS
(2-sided)
6 32 38
Lower Class
15.8% 84.2% 100.0%
630 854 1484
Lower Middle Class
42.5% 57.5% 100.0%
24 4 28
Middle class
85.7% 14.3% 100.0%
0.000
450 312 762
Upper Class
59.1% 40.9% 100.0%
666 394 1060
Upper Middle Class
62.8% 37.2% 100.0%
1776 1596 3372
Total
52.7% 47.3% 100.0%
As per Socio economic status 38 belongs to lower class out of that 36 had done
Phacoemulsification and 32 had done SICS. 1484 belongs to lower middle class out of that
630 had done Phacoemulsification and 854 had done SICS. 28 belongs to middle class out of
that24 had done Phacoemulsification and 8 had done SICS. 762 belongs to upper class out of
that 450 had done Phacoemulsification and 312 had done SICS. 1060 belongs to upper
middle class out of that 666 had done Phacoemulsification and 394 had done SICS. It is
statistically significant

Section II Comorbidities among cases

Table 8: Comorbidities among cases

Surgical Intervention Total Asymptotic

Systemic Comorbidities Significance
Phacoemulsification SICS
(2-sided)
4 0 4
Arthritis in the last 5 years
100.00% 0.00% 100.00%
2 0 2
Asthma in last 10 years
100.00% 0.00% 100.00%
18 42 60
CVD
30.00% 70.00% 100.00%

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287 452 739

Diabetes in the last 2 years
38.80% 61.20% 100.00%
17 21 38
Diabetes in the last 5 years
44.70% 55.30% 100.00%
0 19 19
Diabetes in the last 8 years
0.00% 100.00% 100.00%
1072 556 1628
Healthy
65.80% 34.20% 100.00%
Hypertension & Diabetes 20 30 50
Mellitus in the last 5 years 40.00% 60.00% 100.00%
Hypertension in the last 5 2 4 6 0.000
years 33.30% 66.70% 100.00%
Hypertension in the last 1 32 42 74
years 43.20% 56.80% 100.00%
Hypertension in the last 10 0 68 68
years 0.00% 100.00% 100.00%
Hypertension in the last 12 0 44 44
years 0.00% 100.00% 100.00%
Hypertension in the last 2 298 264 562
years 53.00% 47.00% 100.00%
6 7 13
Thyroid in the last 10 years
46.20% 53.80% 100.00%
0 7 7
Thyroid in the last 20 years
0.00% 100.00% 100.00%
18 40 58
Tuberculosis
31.00% 69.00% 100.00%
Total 1776 1596 3372
52.70% 47.30% 100.00%

The table depicts that 4 patients had arthritis and 2 had Asthma and they had undergone
Phacoemulsification.60 had CVD and out of that 42 had done Phacoemulsification and 18
had done SICS. 739 had diabetes in last 2 years and out of that 452 had done
Phacoemulsification and 287 had done SICS. 38 had diabetes in last 5 years and out of that
17 had done Phacoemulsification and 21 had done SICS. 19 had diabetes in last 8 years and
all had done SICS. 1628 were healthy and out of that 1076 had done Phacoemulsification and
552 had done SICS. 50 had Hypertension & Diabetes Mellitus in the last 5 years and out of
that 20 had done Phacoemulsification and 30 had done SICS. 6 had Hypertension in the last 5
years and out of that 2 had done Phacoemulsification and 4 had done SICS. 74 had
Hypertension in the last 1 years and out of that 32 had done Phacoemulsification and 42 had
done SICS. 68 had Hypertension in the last 10 years and all had done SICS.44 had
Hypertension in the last 12 years and all had done SICS. 562 had Hypertension in the last 2

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years and out of that 298 had done Phacoemulsification and 264 had done SICS. 13 had
Thyroid in the last 10 years and out of that 6 had done Phacoemulsification and 7 had done
SICS. 7 had Thyroid in the last 20 years and all had done SICS. It is statistically significant

Section III: Type of cataract

Table 9: Type of cataract

Asymptotic
Significance
Surgical Intervention Total
Type of Cataract (2-sided)

Phacoemulsification SICS
956 865 1821
Cortical
52.5% 47.5% 100.0%
564 560 1124
Nuclear
50.2% 49.8% 100.0% 0.000
256 171 427
Posterior subcapsular
60.0% 40.0% 100.0%
1776 1596 3372
Total
52.7% 47.3% 100.0%

1821 had cortical cataract and out of that 865 had done Phacoemulsification and 956 had
done SICS. 1124 had nuclear cataract and out of that 560 had done Phacoemulsification and
564 had done SICS. 427 had Posterior subcapsular cataract and out of that 256 had done
Phacoemulsification and 171 had done SICS. It is statistically significant

Section III: Grades of cataract

Table 10: Grade of cataract

Surgical Intervention Asymptotic

GRADE Phacoemulsification SICS Total Significance (2-sided)

II 624 770 1394

44.8% 55.2% 100.0%
III 1026 720 1746
58.8% 41.2% 100.0% 0.000
IV 126 106 232
54.3% 45.7% 100.0%
Total 1776 1596 3372
52.7% 47.3% 100.0%

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1394 had Grade II cataract and out of that 770 had done Phacoemulsification and 624 had
done SICS. 1746 had Grade III cataract and out of that 1026 had done Phacoemulsification
and 720 had done SICS. 232 had Grade IV cataract and out of that 126 had done
Phacoemulsification and 106 had done SICS. It is statistically significant

Section IV: Ocular Comorbidities

Table 11: Ocular Comorbidities

Surgical Intervention Total Asymptotic

Significance
Ocular Phacoemulsification SICS (2-sided)
Comorbidities
ARMD 0 2 2
0.0% 100.0% 100.0%
ARMD, DR 0 16 16
0.0% 100.0% 100.0%
ARMD, HTR 0 12 12
0.0% 100.0% 100.0% 0.000
Diabetic 158 380 538
Retinopathy 29.4% 70.6% 100.0%
Glaucoma 30 86 116
25.9% 74.1% 100.0%
Hypertensive 12 122 134
Retinopathy 9.0% 91.0% 100.0%
Healthy 1576 978 2554
61.7% 38.3% 100.0%
Total 1776 1596 3372
52.7% 47.3% 100.0%

2 had ARMD and all had done SICS. 16 had ARMD, DR cataract all had done SICS. 12 had
ARMD, HTR and all had done SICS. 538 had diabetic retinopathy and out of that 380 had
done Phacoemulsification and 158 had done SICS. 116 had Glaucoma and out of that 30 had
done Phacoemulsification and 86 had done SICS. 134 had Hypertensive retinopathy and out
of that 12 had done Phacoemulsification and 122 had done SICS. 1394 had Grade II
catara2554 were healthy and out of that 1576 had done Phacoemulsification and 978 had
done SICS. It is statistically significant

Section V: Best Corrected Visual Acuity after (BCVA)

Table 12: BCVA after 5 hours

BCVA after Surgical Intervention Total Asymptotic

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5 hours Phacoemulsification SICS Significance

(2-sided)

6/36 41 12 248
95.5% 4.5% 100.0%
6/60 204 15 219
93.2% 6.8% 100.0%
FC at 6 M 1318 1569 2887
45.7% 54.3% 100.0% 0.000

Total 1776 1596 3372

52.7% 47.3% 100.0%

The table showed that Best Corrected Visual Acuity after (BCVA) after 5 hours was 6/36 for
248 participants and out of that 41 had done Phacoemulsification and 12 had done SICS. Best
Corrected Visual Acuity after (BCVA) after 5 hours was 6/60 for 219 participants and out of
that 204 had done Phacoemulsification and 15 had done SICS. Best Corrected Visual Acuity
after (BCVA) after 5 hours was FC at 6M for 2887 participants and out of that 1318 had done
Phacoemulsification and 1569 had done SICS. It is statistically significant

Table 13: BCVA after 5 days

BCVA after Surgical Intervention Total Asymptotic

5 days Significance (2-sided)

Phacoemulsification SICS
6/12 322 184 506
63.6% 36.4% 100.0%
6/18 397 272 669
59.3% 40.7% 100.0%
6/24 93 56 149
62.4% 37.6% 100.0%
6/36 820 988 1808 0.000
45.4% 54.6% 100.0%
6/60 4 0 4
100.0% 0.0% 100.0%
6/9 140 96 236
59.3% 40.7% 100.0%
Total 1776 1596 3372
52.7% 47.3% 100.0%

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Best Corrected Visual Acuity after (BCVA) after 5 days was 6/12 for 506 participants and
out of that 322 had done Phacoemulsification and 184 had done SICS. Best Corrected Visual
Acuity after (BCVA) after 5 days was 6/18 for 669 participants and out of that 397 had done
Phacoemulsification and 272 had done SICS. Best Corrected Visual Acuity after (BCVA)
after 5 days was 6/24 for 149 participants and out of that 93 had done Phacoemulsification
and 56 had done SICS. Best Corrected Visual Acuity after (BCVA) after 5 days was 6/36
for 1808 participants and out of that 820 had done Phacoemulsification and 988 had done
SICS. Best Corrected Visual Acuity after (BCVA) after 5 days was 6/60 for 4 participants
and all had done Phacoemulsification. Best Corrected Visual Acuity after (BCVA) after 5
days was 6/9 for 236 participants and out of that 140 had done Phacoemulsification and 96
had done SICS. It is statistically significant

Table 14: BCVA after 15 days

BCVA after Surgical Intervention Total Asymptotic

15 days Significance (2-
sided)
Phacoemulsification SICS

6/12 323 184 507

63.7% 36.3% 100.0%
6/18 399 272 671 0.000
59.5% 40.5% 100.0%
6/24 626 928 1554
40.3% 59.7% 100.0%
6/36 288 116 404
71.3% 28.7% 100.0%
6/9 140 96 236
59.3% 40.7% 100.0%
Total 1776 1596 3372
52.7% 47.3% 100.0%

Best Corrected Visual Acuity after (BCVA) after 15 days was 6/12 for 507 participants and
out of that 323 had done Phacoemulsification and 184 had done SICS. Best Corrected Visual
Acuity after (BCVA) after 15 days was 6/18 for 671 participants and out of that 399 had done
Phacoemulsification and 272 had done SICS. Best Corrected Visual Acuity after (BCVA)
after 15 days was 6/24 for1554 participants and out of that 626 had done Phacoemulsification
and 928 had done SICS. Best Corrected Visual Acuity after (BCVA) after 15 days was 6/36
for 404 participants and out of that 288 had done Phacoemulsification and 116 had done
SICS. Best Corrected Visual Acuity after (BCVA) after 5 days was 6/9 for 236 participants

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and out of that 140 had done Phacoemulsification and 96 had done SICS. It is statistically
significant

Table 15: BCVA after 30 days

BCVA after Surgical Intervention Total Asymptotic

30 days Significance (2-
Phacoemulsification SICS sided)

6/12 307 177 484

63.4% 36.6% 100.0%
6/18 113 101 214
52.8% 47.2% 100.0%
6/24 629 938 1567
40.1% 59.9% 100.0%
0.000
6/36 284 106 390
72.8% 27.2% 100.0%
6/6 34 30 64
53.1% 46.9% 100.0%
6/9 409 244 653
62.6% 37.4% 100.0%
Total 1776 1596 3372
52.7% 47.3% 100.0%

Best Corrected Visual Acuity after (BCVA) after 30 days was 6/12 for 484 participants and
out of that 307 had done Phacoemulsification and 177 had done SICS. Best Corrected Visual
Acuity after (BCVA) after 30 days was 6/18 for 214 participants and out of that 113 had done
Phacoemulsification and 101 had done SICS. Best Corrected Visual Acuity after (BCVA)
after 30 days was 6/24 for 1567 participants and out of that 629 had done
Phacoemulsification and 938 had done SICS. Best Corrected Visual Acuity after (BCVA)
after 30 days was 6/36 for 390 participants and out of that 284 had done
Phacoemulsification and 106 had done SICS. Best Corrected Visual Acuity after (BCVA)
after 30 days was 6/6 for 64 participants and 34 had done Phacoemulsification and 30 had
done SICS. Best Corrected Visual Acuity after (BCVA) after 30 days was 6/9 for 653
participants and out of that 409 had done Phacoemulsification and 244 had done SICS. It is
statistically significant

Table 16: BCVA after 45 days

BCVA after Surgical Intervention Total Asymptotic

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45 days Phacoemulsification SICS Significance (2-

sided)
6/12 181 90 271
66.8% 33.2% 100.0%
6/18 66 74 140
47.1% 52.9% 100.0%
6/24 625 928 1553
40.2% 59.8% 100.0% 0.000
6/36 288 116 404
71.3% 28.7% 100.0%
6/6 369 223 592
62.3% 37.7% 100.0%
6/9 247 165 412
60.0% 40.0% 100.0%
Total 1776 1596 3372
52.7% 47.3% 100.0%
Best Corrected Visual Acuity after (BCVA) after 45 days was 6/12 for 271 participants and
out of that 181 had done Phacoemulsification and 90 had done SICS. Best Corrected Visual
Acuity after (BCVA) after 45 days was 6/18 for 140 participants and out of that 66 had done
Phacoemulsification and 74 had done SICS. Best Corrected Visual Acuity after (BCVA) after
45 days was 6/24 for 1553 participants and out of that 625 had done Phacoemulsification and
928 had done SICS. Best Corrected Visual Acuity after (BCVA) after 45 days was 6/36 for
404 participants and out of that 288 had done Phacoemulsification and 116 had done SICS.
Best Corrected Visual Acuity after (BCVA) after 45 days was 6/6 for 592 participants and
369 had done Phacoemulsification and 223 had done SICS. Best Corrected Visual Acuity
after (BCVA) after 45 days was 6/9 for 412 participants and out of that 247 had done
Phacoemulsification and 165 had done SICS. It is statistically significant

Section VI: Post-surgical Visual Outcome in different surgical procedure

Table 17: Post-surgical Visual Outcome in different surgical procedure.

Post-surgical Surgical Intervention Total Asymptotic

Visual Outcome Significance (2-
Phacoemulsification SICS sided)
0 (Good) 863 552 1415

61.0% 39.0% 100.0%

1 (Poor) 913 1044 1957

46.7% 53.3% 100.0% 0.000

Total 1776 1596 3372

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52.7% 47.3% 100.0%

Type of surgery and visual Outcome: Among 3372 participants 1776 went for
phacoemulsification, out of them 863 (61.0%) got good visual outcome and 913 (39.0%) got
poor visual outcome. 1596 patients underwent SICS, out of them only 522 (34.6%) got good
outcome and 1044 (53.3%) got poor visual outcome. It is statistically significant

The average size of incision in cases undergoing cataract extraction by phacoemulsification

technique was around 2.8 mm; and that of cases undergoing SICS was 5.5 mm. Surgically
induced astigmatism in both the operating techniques ranged from 0-2 diopters (D). Among
3372 participants, 1776 (52.7%) underwent for Phacoemulsification and remaining 1596
(47.3%) selected for Small Incision Cataract Surgery (SICS). 1207 (68%) patients out of
1776 those who underwent phacoemulsification had surgically induced astigmatism in the
range 0.6-1D; whereas 532 (30%) cases had in the range of 0-0.5D and only 18 (1%) case
had in the range of 1.1-1.5D. Whereas, amongst the 1596 cases who had undergone SICS,
862 (54%) cases had surgically induced astigmatism in the range of 0.6-1D, 479 (30%) cases
had in the range of 1.1-1.5D, 160 (10%) cases had between 1.6-2D,and only 96 (6%) cases
had 0-0.5D. Mean astigmatism following phacoemulsification technique was found to be
0.64D, and that following SICS was 1.12D.

Discussion

This prospective study was conducted to evaluate the impact of cataract surgery on the visual
outcome of individuals who underwent two different M-SICS and Phacoemulsification
techniques. The visual outcome achieved on the postoperative day was better in
Phacoemulsification than SICS. Ruit et al. 6 compared the efficacy and visual results of
phacoemulsification versus MSICS for the treatment of cataracts. They compared different
parameters including UCVA and BCVA. They found that both the surgical techniques
achieved excellent surgical outcomes with low complication rates. At 6 months, 89% of the
SICS patients had an UCVA of 20/60 or better and 98% had a BCVA of 20/60 or better
versus 85% of patients with UCVA of 20/60 or better and 98% of patients with BCVA of
20/60 or better at 6 months in the phaco group. They also mentioned that the surgical time for
MSICS was much shorter than that for phacoemulsification, and they concluded that MSICS
is an appropriate surgical procedure for the treatment of advanced cataracts. Imtiyaz et al. 7
conducted a study on 115 patients concerned with visual rehabilitation after MSICS. They
found that 70 (60.8%) patients improved to an UCVA of 6/12 or better in the third week only
and 88 (76.52%) patients had an UCVA of 6/12 or better by the end of 12th week.

Conclusion

Phacoemulsification technique has the advantage of early visual rehabilitation after cataract
surgery and this is mainly attributed to the small incision size used. The phacoemulsification
was better surgical option for cataract surgery compared to SICS. Unaided visual acuity was

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better in cases undergone phacoemulsification than SICS, as the induced astigmatism is much
less in cases of phacoemulsification.

Conflict of Interest: The authors certify that they have no involvement in Any organization
or entity with any financial or non-financial interest in the subject matter or materials
discussed in this paper.

Funding Source: There is no funding Source for this study

Acknowledgement: I most sincerely convey my deep sense of gratitude to my

guide/Organisation for her/their remarkable guidance and academic support during this study.

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