Our Summary

Cataracts cause blindness in about 20 million people around the world, with most of these people living in developing countries. Manual small-incision cataract surgery (MSICS) has become a cost-effective alternative to a more common method known as phacoemulsification, and it offers similar outcomes in terms of improving vision. One of the critical factors that determine the success of the surgery is the condition of the corneal endothelium, a thin layer of cells on the back of the cornea.

Several factors can cause damage to the cornea during cataract surgery, including corneal distortion, the turbulence of the solution used to irrigate the eye, mechanical trauma by surgical instruments, contact with the artificial lens, and free oxygen radicals. MSICS has been shown to cause a loss of about 16% of endothelial cells, a rate similar to that of other cataract surgery methods.

However, proper evaluation of the endothelium before surgery, and taking necessary precautions to protect it during the operation, can reduce this cell loss and decrease the risk of a condition known as pseudophakic bullous keratopathy, which can cause vision loss and eye discomfort. The type of solution used to irrigate the eye, the viscoelastic devices used to maintain the shape of the eye during surgery, the dyes used to visualize the structures of the eye, and the drugs administered also all play a role in preserving the health of the endothelial cells.

This paper reviews existing research on how to protect these cells during MSICS, which is particularly important in developing countries where large numbers of these surgeries are performed to reduce the incidence of cataract-related blindness.

FAQs

  1. What is Manual Small-Incision Cataract Surgery (MSICS) and how does it compare to other methods in terms of visual gain?
  2. What factors can cause corneal damage during cataract surgery?
  3. How can damage to the corneal endothelium be minimized during cataract surgery?

Doctor’s Tip

A helpful tip a doctor might tell a patient about cataract surgery is to follow all preoperative instructions provided by the surgeon, including taking any prescribed medications and avoiding eating or drinking before the surgery. It is also important to discuss any concerns or questions with the surgeon before the procedure to ensure a successful outcome. Additionally, following postoperative care instructions, such as using prescribed eye drops and attending follow-up appointments, is crucial for a smooth recovery process.

Suitable For

Patients who are typically recommended for cataract surgery are those who have significant visual impairment due to cataracts that is affecting their daily activities and quality of life. Additionally, patients with cataracts that are causing other complications such as glaucoma, macular degeneration, or diabetic retinopathy may also be recommended for cataract surgery. The decision to undergo cataract surgery is typically made after a thorough evaluation by an ophthalmologist, taking into consideration the severity of the cataracts and the overall health of the patient. In developing countries where manual small-incision cataract surgery is commonly performed, protecting the corneal endothelium during surgery is important to minimize complications such as pseudophakic bullous keratopathy.

Timeline

  • Before cataract surgery:
  1. Patient experiences blurred or cloudy vision, difficulty seeing at night, sensitivity to light, and seeing halos around lights.
  2. Patient undergoes preoperative assessment to determine the status of the corneal endothelium and overall eye health.
  3. Surgical plan is discussed with the patient, including the type of surgery (such as manual small-incision cataract surgery) and the type of intraocular lens to be implanted.
  • After cataract surgery:
  1. Patient undergoes the surgical procedure, during which multiple factors such as corneal distortion, irrigation solution turbulence, mechanical trauma by instruments, and free oxygen radicals may affect the corneal endothelium.
  2. Postoperative care includes monitoring the patient for any signs of complications, such as increased intraocular pressure or inflammation.
  3. Patient may experience improved vision within a few days to weeks after surgery, depending on the individual healing process.
  4. Long-term follow-up is important to monitor the health of the corneal endothelium and overall eye health.

What to Ask Your Doctor

  1. What are the potential risks and complications associated with cataract surgery?
  2. How will my vision be affected immediately after surgery, and how long will it take for my vision to fully improve?
  3. What type of intraocular lens will be used, and what are the potential benefits and drawbacks of each option?
  4. Will I need to wear glasses or contact lenses after surgery, and if so, for how long?
  5. How long is the recovery period, and when can I return to my normal daily activities?
  6. What steps will be taken to protect my corneal endothelium during surgery?
  7. What measures will be taken to prevent infection during and after the surgery?
  8. How often will I need to follow up with you after the surgery, and what should I do if I experience any complications or concerns?
  9. Are there any specific lifestyle changes or precautions I should take before or after the surgery to ensure the best possible outcome?
  10. Are there any alternative treatment options to consider, and how do they compare to cataract surgery in terms of effectiveness and safety?

Reference

Authors: Singh M, Mishra D, Sinha BP, Anand A, Singhal S. Journal: Indian J Ophthalmol. 2022 Nov;70(11):3791-3796. doi: 10.4103/ijo.IJO_1048_22. PMID: 36308098