Outcomes of manual small incision cataract surgery in hypermature/morgagnian cataract.

PURPOSE: To evaluate the visual outcome and complication rate of manual small incision cataract surgery (MSICS) in hypermature morgagnian cataract (HMC). SETTING: Aravind Eye Hospital, Pondicherry, India. DESIGN: Retrospective, single center study. METHODS: Case records of patients diagnosed with HMC and who underwent MSICS from January to December 2019 were retrospectively collected. Data were analyzed for demographic details, preoperative risk factors, intraoperative/postoperative complications, and visual outcome at 1-month follow-up. RESULTS: 105 patients were included in the study. Preoperative risk factors like dense pseudoexfoliation were seen in 6 patients (5.7%), phacolytic glaucoma in 7 patients (6.7%), lens induced uveitis in 5 (4.7%), and phacodonesis in 30 patients (28.5%). Overall intraoperative complication rate was 14.3%, which included posterior capsular rent (n = 4), zonular dialysis (n = 7), and whole bag removal (n = 4). Due to poor posterior capsular bag support, 7 patients (6.6%) did not receive intraocular lens implantation in primary surgery. Both the intraoperative and postoperative complication rate were high in those with risk factors, and this difference was statistically significant ( P < .001 and .0005, respectively). On the first postoperative day, 70 patients (66.7%) had a corrected distance visual acuity (CDVA) better than 20/40, and at 1 month, 98 patients (93.3%) had a CDVA of 20/60 or better of which 89.5% had CDVA of ≥20/40. CONCLUSIONS: MSICS for hypermature cataract is relatively safe and yields adequate visual outcome. Preoperative risk factors, in addition to hypermaturity, increase the complication rate.

Effect of Video Counselling Versus Verbal Counselling on Patient's experience during phacoemulsification under topical anaesthesia.

Purpose: To evaluate the impact of video and verbal counselling on patients' undergoing phacoemulsification under topical anaesthesia. Methods: This is a prospective randomized controlled trial conducted at Aravind Eye Care System, Pondicherry, India. All patients had a 15 â€‹min one-on-one verbal counselling covering surgical technique, implant options, anaesthesia and payment options one day prior to surgery. On the day of surgery, patients were randomized into two groups; in the first group, patients were provided with video counselling and in the second group, patients were given verbal counselling prior to undergoing phacoemulsification under topical anaesthesia. Measurements of blood pressure, heart rate, respiration rate, and the Likert-scale anxiety rating were collected at preoperative, perioperative, and postoperative time points. Results: A group of 186 patients (aged 45-70 years) were provided video counselling via portable iPad before first-time phacoemulsification, and a second group of 186 patients underwent surgery with verbal counselling. Systolic and diastolic blood pressure measurements were lower in both the video and verbally counselled groups during the intraoperative time point. Furthermore, during the intraoperative period, 123 (66.1%) video counselled patients felt relaxed compared to 119 (64%) patients who were provided verbal counselling (P â€‹= â€‹0.6636). Patient cooperation during surgery was excellent in 76(40.9%) video counselled patients and 67(36%) verbally counselled patients (P â€‹= â€‹0.3374). 25.8% and 21% (P â€‹= â€‹0.2703) of patients experienced no pain during surgery in the video and verbal counselled groups respectively. Conclusions: Although measures such as pulse rate, respiratory rate and feelings of relaxation did not show significant differences among the two groups of video and verbal counselling, patients marked cooperation during surgery and furthermore, the level of anxiety is most reassuring.