Effect of cataract surgery (phaco and manual small surgery) incision cataract on the corneal endothelium - a comparative study.

Geetha, P (2007) Effect of cataract surgery (phaco and manual small surgery) incision cataract on the corneal endothelium - a comparative study. Masters thesis, Madras Medical College, Chennai.


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Over the years from Susruta's couching to Charles. D. Kelman's Phacoemulsification, cataract surgery has witnessed a phenomenal progress. The successful cataract surgery is determined by the best and the earliest possible visual rehabilitation. Introduction of phacoemulsification by Kelman and no - stich surgery by McFarland are the major advances in reduction of destruction of the endothelium and quick visual rehabilitation. Charles D. Kelman the pioneer in phaco surgery has written in one of his books "Those of us who perform the technique become enamored of the procedure, elated by the white, quiet post of eyes, proud of the work as an artist is proud of his and empathetic with the patient who back at work the next day proclaim that he had a cataract removed the day before and has no physical limitation". It seem we are now very close to ideal cataract surgery - our ultimate goal. Successful cataract surgery depends on the good endothelial count pre operatively and post operatively. This observation of corneal endothelium by specular reflection date back to the early past of 20th century by Vogt demonstrated the first direct visualisation of corneal endothelial cells using principle of specular microscopy in 1918 using S/L bio microscope. We hope that this corneal endothelial study helps us to chose an ideal technique for extraction of cataractous lens in order to get a good visual rehabilitation in immediate post operative period as mentioned by our pioneer - our ultimate goal. Cornea provides 75% of the refractive power of the eye and corneal transparency is required for clear vision. The corneal endothelium is a single cell layer lining the inner surface of cornea and plays an important role in corneal deturgescence. The normal cornea at birth has a high endothelial cell density. The range of cell counts for individuals 40 - 90 years of age is 1500 - 3500 cells // mm2. The purpose of study is to ascertain whether there is any alteration in endothelial counts by various techniques of cataract surgery. Endothelial cell count loss by this study was found to be less with phaco surgery than with manual SICS. The endothelial cells loss attributed to the phaco surgery by this study was found to be mostly due to intra operative complication like post capsular rupture with vitreous disturbance, increased irrigation in the anterior chamber, increased phaco time in few cases and sometimes due to difficulty in IOL manipulation. The optical property of the cornea can be maintained by protecting, endothelium by following a proper technique in all the steps right from the incision to implantation of IOL. Phaco surgery was found to be superior to manual SICS by ensuring minimal injury to the endothelial cells and thus provides a good BCVA when compared to manual SICS immediately after the surgery thus providing a quicker visual recovery.

Item Type: Thesis (Masters)
Uncontrolled Keywords: cataract surgery; phacosurgery; manual small surgery; incision cataract; corneal endothelium
Subjects: MEDICAL > Ophthalmology
Depositing User: Devi S
Date Deposited: 20 Jul 2017 12:06
Last Modified: 20 Jul 2017 12:06
URI: http://repository-tnmgrmu.ac.in/id/eprint/2035

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