Clinical Evaluation of a Modified Scleral Tunnel Technique for Manual Small-Incision Cataract Surgery in Low-Resource Settings

Abstract

Background: Manual small-incision cataract surgery (MSICS) is an effective and affordable option for cataract management in low-resource settings.

Objective: To evaluate the clinical outcomes of a modified scleral tunnel technique for manual small-incision cataract surgery in low-resource settings, with assessment of visual recovery, surgically induced astigmatism, wound stability, and surgical complications.

Material and Methods: This prospective interventional study was conducted at Department of Opthalmology Nishtar Hospital Multan from June 2022 to January 2023, included 85 patients with visually significant age-related cataract who underwent MSICS using a modified scleral tunnel technique. Preoperative and postoperative visual acuity, corneal astigmatism, wound stability, and intraoperative and postoperative complications were recorded.

Results: The mean age of the patients was 62.7 ± 8.9 years, and 46 (54.1%) were male. Mean best-corrected visual acuity improved from 1.18 ± 0.42 logMAR preoperatively to 0.19 ± 0.14 logMAR at 6 weeks (p<0.001). At final follow-up, 76 (89.4%) patients achieved BCVA of 6/18 or better. Mean surgically induced astigmatism was 0.74 ± 0.39 D. A self-sealing wound was achieved in 81 (95.3%) patients, while 4 (4.7%) required suturing. The most common postoperative complication was corneal edema in 7 (8.2%) patients, followed by anterior chamber inflammation in 5 (5.9%).

Conclusion: The modified scleral tunnel technique for MSICS showed favorable short-term outcomes, including significant improvement in visual acuity, low surgically induced astigmatism, a high rate of self-sealing wounds, and a low frequency of complications.

Keywords: cataract, manual small-incision cataract surgery, scleral tunnel, visual acuity, surgically induced astigmatism