6.0 Brief resume of intended work

6.1 Need for study

Cataract is the major cause of blindness in world. The “right to sight” is the common global agenda launched by WHO and aim is to reduce present blindness rate to about 25 million by year 2020. There is technological explosion in the field of cataract surgery. For developing countries which can ill afford an expensive technology for masses, manual small incision cataract surgery has come in as savior being simple and effective. It is safe and devoid of expensive machinery. In infancy cornea is spherical and throughout childhood and adolescence, astigmatism with the rule develops and as the age advances cornea becomes more spherical and develops against the rule asigrnatism with senescence. There is development of against the rule astigmatism after cataract surgery most of the times, which worsens the preexisting astigmatism when incision taken superior, the same is minimized is and well controlled when section is made temporally. Hence there is need of comparative study of superior versus temporal incision in manual small incision cataract surgery to reduce post operative astigmatism for good post operative visual recovery.

6.2 Review of Literature

1.  1n1990 the sutureless incision was developed. which utilized a longer scleral tunnel with linear grooves in the floor of the tunnel in the meridian of incision. The temporal sutureless clear cornea! incision for cataract surgery was described in 1992, now it has become the favoured techinique for cataract surgery in conjunction with foldable or small incision IOL for many surgeons internationally.

2.  Ahmed Abd El Mageed Radwan et al. To compare the astigmatism induced by superior v/s temporal incision in manual SICS in eyes with preoperative “with the rule” corneal astigmatism in 20 eyes of 1 5 patients at “Am Shams University Hospitals”. Concluded as the incision site affects the post-operative astigmatism; a shift in the incision site to temporal sclera is recommended.

3.  Bhaskar Reddy. Amit Raj and Virendar Pratap Singh. Studied the site of Incision and Corneal Astigmatism in Conventional SICS versus Phacoemulsification. A total of 64 eyes of 64 patients (34 male/30 female) with a mean age of 62.1 0 years (range 45—82 years) were included in the study. The cases were randomly divided into two groups. One group (Group I) had undergone manual STCS. The manual SICS group patients were randomly allotted into two subgroups depending on the site of incision. Group Ia received superior incision while group lb received temporal incision. At 90 days. conventional SICS superior incisions gave 1.92 ± 0.53 D against the rule and temporal incisions 1 .57 ± 0.24 D with the rule astigmatism.

4.  M. Kumaran, R. Babu, V. Ganesh., did comparative analytical study of surgically induced astigmatism in superior versus temporal manual small incision cataract surgery. Study was conducted on 100 eyes with senile cataract they were randomly divided into two groups. In one group (50 patients) superior incision taken. Group two (50 patients) temporal incision taken. They concluded a temporal approach to MSICS is best in minimizing surgically induced astigmatism and reducing preexisting against the rule astigmatism and reducing the need for astigmatic keratotomy.

5.  Dr. Shantanu Mukherji et al.. presented paper on Temporal SICS: Practical advantages and great results at low cost-our experience. Their study elicited the relative advantages of temporal SICS vis a vis superior approach, especially in high volume setting. Many significant advantages were perceived, notably temporal SICS being best suited for deep-seated eyes, minimal globe manipulation and lesser induced astigmatism. 612 cases were operated temporally and had excellent visual outcome. Temporal SICS is a safe and easy procedure and in view of majority of patients having preoperative ‘ATR’ astigmatism-it is the procedure of choice.

6.  V. Reddy Aetigadda, A Raj, V. Singh. Studied surgically induced astigmatism in phacoemulsification versus conventional SICS. 64 eyes of 64 patients with a mean age of 45-82 years were included in study. Cases were divided into two groups randomly, one group had undergone MSICS and other phacoemulsification. The MS ICS group patients were randomly allotted into two subgroups depending on the site of incision. Group Ia received superior and Group lb received temporal incision. They found significant against the rule shift in astigmatism in phacoemulsification and MS ICS superior incision. The manual SICS group with temporal incision (Ib) had with the rule shift in astigmatism.

6.3 Objective of the study

·  To compare the astigmatism induced by superior v/s temporal incision in manual SICS.

·  To know the visual outcome in SICS.

·  To know how to minimize the post operative astigmatism by changing the site of incision.

·  To correct preexisting astigmatism.

7. Materials and Methods

7.1 Source of data

Patients of age 40 years cataract admitted to Basaveshwar Teaching Gulbarga. — 70 years ophthalmic & General with senile wards Hospital,


7.2 Methods of collection of data

  1. The study will be carried out for 2 years and total of 200 cataract cases will be included in the study.
  2. Each cases will be examined with detailed history, regarding their complaints, the onset and duration of symptom.
  3. Pre operative V/A, recording, Retinoscopy, Slitlamp examination, Karatometry. Biometry will be done and recording of preexisting astigmatism. Applanation torometry and calculation of IOL power by SRK — II formula. Fundus examination will be carried out.
  4. After obtaining written consent patient will be subjected to manual small incision cataract surgery under . PBB (LA), by randomly dividing into 2 groups with PMMA PCIOL implantation. In the series comparative analysis of preoperative and postoperative pattern of astigmatism studied.
  5. During follow up assessment of operation

·  V/A will be taken,

·  Anterior segment examination of with slitlamp biomicroscope.

·  Retinoscopy

·  Keratometry

·  Fundoscopy (direct/ indirect) will be studied and recorded. Patient will be followed upon first postoperative day. 7th and 21st day. All above mentioned examination will be repeated. The resultant astigmatism will be calculated by retinoscopy, K1 and K2 readings and will be compared with pre operation values.

Inclusion Criteria:

All patients of age 40-70 years of either sex with senile mature and immature cataract who will be screened at ophthalmology OPD BTGH and admitted to ophthalmology wards at BTGH without involvement of posterior segment.

Exclusion Criteria:

  1. Patients with congenital and developmental cataract.
  2. Patients with complicated or traumatic cataract.
  3. Patents with preexisting corneal opacity uveitis, glaucoma. dacryocystitis and macular degeneration which independently cause limitation of vision.


7.3 Does the sliding require any investigations or interventions to be conducted on patients or human or animals? If so please describe.

Yes.

Minimum investigation like:

Blood for Hb%, TC, DC. ESR,

Urine for sugar Aib. Microscopic study,

RBS.

BP recording

Ophthalmic examination will include.

·  Clinical evaluation

·  Preoperative visual acuity. Retinoscopy

·  Slitlamp examination

·  Fundus examination

·  lOP measurement using schiotz tonometer.

·  Patency of lacrimal passages Keratometry reading using busch and lomb keratometer

·  Power of the PCIOL is calculated by axial length and K1, K2 by using SRK-II formula which is incorporated into “A scan unit”.

7.4 Has ethical clearance been Obtained from yin case of 7.3?

YES.

Ethical clearance has been obtained from ethical committee, M.R. Medical College, Gulbarga.

8. List of References

  1. Ahmed Abd El Mageed Radwan, MD; Mohamed kabeel, MD and Hussein Swelem, MD. Change of incision site reduces astigmatism in manual small incision cataract surgery. Paper presentation on Sept. 7th 2007 @ EOS Summer Meeting, 6-7 September 2007. Renaissence Alexandria Hotel 544 Avenue El-Geish. Sidi Bishr, Alexandria, Egypt.
  2. Bhaskar Reddy, Amit Raj and Virendar Pratap Singh. Site of Incision and Corneal Astigmatism in Conventional SICS versus Phacoemulsification. Annals of Ophthalmology. Published online 20” Sept. 2007.
  3. Howard Fine. Mark Parker, RichardsHoffaman ,Chapter No. 47 “Small incision caract surgery” in “Mayron Yannoff Jay’ s Ducker Ophthalmology” 6th edition 2004 vol. No 1 -349
  4. M. Kumaran, R. Babu. V. Ganesh. Comparative analytical study of surgically induced astigmatism in superior versus temporal manual small incision cataract surgery. Asian Journal of ophthalmology 2007; vol 9. No. I supplement 1: 195.
  5. Dr. Shantanu Mukherji. Temporal SICS: Practical advantages & Great results at low cost our experiences. 65’th All India Ophthalmologic Conference 2007 @ Hyderabad: Paper presentation 2-2-2007.
  6. V. Reddy Aetigadda. A Raj. V. Singh. Surgically induced astigmatism phacoemul sifaction versus conventional SICS. Asian Journal of Ophthalmology. 2007; vol 9, No. 1 supplement 1: 196.