CORTICAL CLEANUP WITHOUT SIDE PORT IN SMALL INCISION CATARACT SURGERY

• Published in: Journal of evolution of medical and dental sciences Vol. 4; no. 96; pp. 16181 - 16184
• Main Authors: Kumar, D. Udaya, Satyavathi, G, Khadari, M.H
• Format: Journal Article
• Language: English
• Published: Akshantala Enterprises Private Limited 30.11.2015
• Subjects: Cataracts; Eye surgery; Genetic disorders; Glaucoma; Ice cream; Ophthalmic agents; Ophthalmology
• ISSN: 2278-4748; 2278-4802
• DOI: 10.14260/jemds/2015/2376

The aim of study was to achieve complete cortical cleanup and avoid problems related with sideport during Small Incision Cataract Surgery (SICS) so as to have a good visual out come with minimal recovery period, and a better quality of life. After nucleus delivery, cortical cleanup is an important step in any cataract surgical procedure. Cortex especially subincisional area (11 to 1 o'clock) is difficult to manage intraoperatively. Bimanual irrigation aspiration through two side ports, aspiration by J cannula, iris massage manoeuver, ice cream scoop manoeuver are various techniques of cortical matter aspiration. We acquired the technique of aspiration of subincisional cortex without using side port in all cases by paying attention on type of cataract, status of pupil, use of Adrenalin mixed BSS intraoperatively, Tunnel construction, Capsulorhexis size and capsular rim size at 12 o'clock. MATERIAL AND METHODS In this retrospective study of 1 year from 2013 to 2014, 60 patients (60 eyes) aged 40 years or older attending the General Ophthalmic Department were included in the study group with another group of 60 patients (60 eyes) as controls. The study was on age related cataracts which are basically. 1) Cortical cataract 2) Nuclear cataract 3) Subcapsular cataract. Proper assessment of cortical cataract based on its maturity such as a) Immature b) Mature c) Hyper mature and d) Morgagnian cataract, nucleus for its opalescence and color, size of posterior subcapsular opacity and pupillary status (Dilating well or not with mydriatics) were taken into consideration. Eyes with pseudoexfoliation having poor pupillary dilation were also included. Eyes with congenital anomalies, congenital cataract, gross corneal and retinal pathologies, and glaucoma were excluded. RESULTS Among 60 study eyes in the study group 35 presented with cortical, 20 with nuclear cataract and 5 with posterior subcapsular cataracts. In 58(96.6%) cases, sideport was not required; 3(5%) eyes had difficulty in aspiration of cortical matter at subincisional area of which 2 eyes (3.3%) required side port. Intraoperative miosis was prevented (100%) by Adrenalin mixed BSS in study group, but it was in 8(13%) eyes of controls. Postoperatively, minimal lens matter was seen in 1(1.6%) eye with no post-operative reaction or Posterior Capsular Opacification (PCO) at 6 months followup. Descemets membrane separation was nil (100%) in study group, which was seen in 8(13%) cases of controls at final followup of 6 months, which might be the cause for some postoperative discomfort in some patients in an otherwise normal eye. CONCLUSION Without side port cortical clean up in 360 degrees is possible in small incision cataract surgery by taking adequate measures. Use of side port may be limited to some selective cases of small pupil especially in those having exfoliation. KEYWORDS SICS, Side Port, Adrenalin Mixed BSS, Pseudoexfoliation(PFX), Capsulorhexis.