Journal of Clinical and Diagnostic Research, ISSN - 0973 - 709X

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Dr Archana Dambal

"Journal of clinical and diagnostic research is a welcome change in publishing practices. It aims to reach out to the grass-root level researchers who do not lack in experience, clinical material and ideas, but lack in their knowledge in English language and statistics. The journal achieves it's aim by supporting in these exact domains.
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Dr. Archana Dambal
Department of General Medicine,
Belgaum Institute of Medical Sciences,Belgaum, Karnataka,INDIA,
On 30 Nov 2018




Dr Bhanu K Bhakhri

"The Journal of Clinical and Diagnostic Research (JCDR) has been in operation since almost a decade. It has contributed a huge number of peer reviewed articles, across a spectrum of medical disciplines, to the medical literature.
Its wide based indexing and open access publications attracts many authors as well as readers
For authors, the manuscripts can be uploaded online through an easily navigable portal, on other hand, reviewers appreciate the systematic handling of all manuscripts. The way JCDR has emerged as an effective medium for publishing wide array of observations in Indian context, I wish the editorial team success in their endeavour"



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Faculty, Pediatric Medicine
Super Speciality Paediatric Hospital and Post Graduate Teaching Institute, Noida
On Sep 2018




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Department of Dematolgy,
Believers Church Medical College,
Thiruvalla, Kerala
On Sep 2018




Prof. Somashekhar Nimbalkar

"Over the last few years, we have published our research regularly in Journal of Clinical and Diagnostic Research. Having published in more than 20 high impact journals over the last five years including several high impact ones and reviewing articles for even more journals across my fields of interest, we value our published work in JCDR for their high standards in publishing scientific articles. The ease of submission, the rapid reviews in under a month, the high quality of their reviewers and keen attention to the final process of proofs and publication, ensure that there are no mistakes in the final article. We have been asked clarifications on several occasions and have been happy to provide them and it exemplifies the commitment to quality of the team at JCDR."



Prof. Somashekhar Nimbalkar
Head, Department of Pediatrics, Pramukhswami Medical College, Karamsad
Chairman, Research Group, Charutar Arogya Mandal, Karamsad
National Joint Coordinator - Advanced IAP NNF NRP Program
Ex-Member, Governing Body, National Neonatology Forum, New Delhi
Ex-President - National Neonatology Forum Gujarat State Chapter
Department of Pediatrics, Pramukhswami Medical College, Karamsad, Anand, Gujarat.
On Sep 2018




Dr. Kalyani R

"Journal of Clinical and Diagnostic Research is at present a well-known Indian originated scientific journal which started with a humble beginning. I have been associated with this journal since many years. I appreciate the Editor, Dr. Hemant Jain, for his constant effort in bringing up this journal to the present status right from the scratch. The journal is multidisciplinary. It encourages in publishing the scientific articles from postgraduates and also the beginners who start their career. At the same time the journal also caters for the high quality articles from specialty and super-specialty researchers. Hence it provides a platform for the scientist and researchers to publish. The other aspect of it is, the readers get the information regarding the most recent developments in science which can be used for teaching, research, treating patients and to some extent take preventive measures against certain diseases. The journal is contributing immensely to the society at national and international level."



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Professor and Head
Department of Pathology
Sri Devaraj Urs Medical College
Sri Devaraj Urs Academy of Higher Education and Research , Kolar, Karnataka
On Sep 2018




Dr. Saumya Navit

"As a peer-reviewed journal, the Journal of Clinical and Diagnostic Research provides an opportunity to researchers, scientists and budding professionals to explore the developments in the field of medicine and dentistry and their varied specialities, thus extending our view on biological diversities of living species in relation to medicine.
‘Knowledge is treasure of a wise man.’ The free access of this journal provides an immense scope of learning for the both the old and the young in field of medicine and dentistry as well. The multidisciplinary nature of the journal makes it a better platform to absorb all that is being researched and developed. The publication process is systematic and professional. Online submission, publication and peer reviewing makes it a user-friendly journal.
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I wish JCDR a great success and I hope that journal will soar higher with the passing time."



Dr Saumya Navit
Professor and Head
Department of Pediatric Dentistry
Saraswati Dental College
Lucknow
On Sep 2018




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Dr. Arunava Biswas
MD, DM (Clinical Pharmacology)
Assistant Professor
Department of Pharmacology
Calcutta National Medical College & Hospital , Kolkata




Dr. C.S. Ramesh Babu
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Best regards,
C.S. Ramesh Babu,
Associate Professor of Anatomy,
Muzaffarnagar Medical College,
Muzaffarnagar.
On Aug 2018




Dr. Arundhathi. S
"Journal of Clinical and Diagnostic Research (JCDR) is a reputed peer reviewed journal and is constantly involved in publishing high quality research articles related to medicine. Its been a great pleasure to be associated with this esteemed journal as a reviewer and as an author for a couple of years. The editorial board consists of many dedicated and reputed experts as its members and they are doing an appreciable work in guiding budding researchers. JCDR is doing a commendable job in scientific research by promoting excellent quality research & review articles and case reports & series. The reviewers provide appropriate suggestions that improve the quality of articles. I strongly recommend my fraternity to encourage JCDR by contributing their valuable research work in this widely accepted, user friendly journal. I hope my collaboration with JCDR will continue for a long time".



Dr. Arundhathi. S
MBBS, MD (Pathology),
Sanjay Gandhi institute of trauma and orthopedics,
Bengaluru.
On Aug 2018




Dr. Mamta Gupta,
"It gives me great pleasure to be associated with JCDR, since last 2-3 years. Since then I have authored, co-authored and reviewed about 25 articles in JCDR. I thank JCDR for giving me an opportunity to improve my own skills as an author and a reviewer.
It 's a multispecialty journal, publishing high quality articles. It gives a platform to the authors to publish their research work which can be available for everyone across the globe to read. The best thing about JCDR is that the full articles of all medical specialties are available as pdf/html for reading free of cost or without institutional subscription, which is not there for other journals. For those who have problem in writing manuscript or do statistical work, JCDR comes for their rescue.
The journal has a monthly publication and the articles are published quite fast. In time compared to other journals. The on-line first publication is also a great advantage and facility to review one's own articles before going to print. The response to any query and permission if required, is quite fast; this is quite commendable. I have a very good experience about seeking quick permission for quoting a photograph (Fig.) from a JCDR article for my chapter authored in an E book. I never thought it would be so easy. No hassles.
Reviewing articles is no less a pain staking process and requires in depth perception, knowledge about the topic for review. It requires time and concentration, yet I enjoy doing it. The JCDR website especially for the reviewers is quite user friendly. My suggestions for improving the journal is, more strict review process, so that only high quality articles are published. I find a a good number of articles in Obst. Gynae, hence, a new journal for this specialty titled JCDR-OG can be started. May be a bimonthly or quarterly publication to begin with. Only selected articles should find a place in it.
An yearly reward for the best article authored can also incentivize the authors. Though the process of finding the best article will be not be very easy. I do not know how reviewing process can be improved. If an article is being reviewed by two reviewers, then opinion of one can be communicated to the other or the final opinion of the editor can be communicated to the reviewer if requested for. This will help one’s reviewing skills.
My best wishes to Dr. Hemant Jain and all the editorial staff of JCDR for their untiring efforts to bring out this journal. I strongly recommend medical fraternity to publish their valuable research work in this esteemed journal, JCDR".



Dr. Mamta Gupta
Consultant
(Ex HOD Obs &Gynae, Hindu Rao Hospital and associated NDMC Medical College, Delhi)
Aug 2018




Dr. Rajendra Kumar Ghritlaharey

"I wish to thank Dr. Hemant Jain, Editor-in-Chief Journal of Clinical and Diagnostic Research (JCDR), for asking me to write up few words.
Writing is the representation of language in a textual medium i e; into the words and sentences on paper. Quality medical manuscript writing in particular, demands not only a high-quality research, but also requires accurate and concise communication of findings and conclusions, with adherence to particular journal guidelines. In medical field whether working in teaching, private, or in corporate institution, everyone wants to excel in his / her own field and get recognised by making manuscripts publication.


Authors are the souls of any journal, and deserve much respect. To publish a journal manuscripts are needed from authors. Authors have a great responsibility for producing facts of their work in terms of number and results truthfully and an individual honesty is expected from authors in this regards. Both ways its true "No authors-No manuscripts-No journals" and "No journals–No manuscripts–No authors". Reviewing a manuscript is also a very responsible and important task of any peer-reviewed journal and to be taken seriously. It needs knowledge on the subject, sincerity, honesty and determination. Although the process of reviewing a manuscript is a time consuming task butit is expected to give one's best remarks within the time frame of the journal.
Salient features of the JCDR: It is a biomedical, multidisciplinary (including all medical and dental specialities), e-journal, with wide scope and extensive author support. At the same time, a free text of manuscript is available in HTML and PDF format. There is fast growing authorship and readership with JCDR as this can be judged by the number of articles published in it i e; in Feb 2007 of its first issue, it contained 5 articles only, and now in its recent volume published in April 2011, it contained 67 manuscripts. This e-journal is fulfilling the commitments and objectives sincerely, (as stated by Editor-in-chief in his preface to first edition) i e; to encourage physicians through the internet, especially from the developing countries who witness a spectrum of disease and acquire a wealth of knowledge to publish their experiences to benefit the medical community in patients care. I also feel that many of us have work of substance, newer ideas, adequate clinical materials but poor in medical writing and hesitation to submit the work and need help. JCDR provides authors help in this regards.
Timely publication of journal: Publication of manuscripts and bringing out the issue in time is one of the positive aspects of JCDR and is possible with strong support team in terms of peer reviewers, proof reading, language check, computer operators, etc. This is one of the great reasons for authors to submit their work with JCDR. Another best part of JCDR is "Online first Publications" facilities available for the authors. This facility not only provides the prompt publications of the manuscripts but at the same time also early availability of the manuscripts for the readers.
Indexation and online availability: Indexation transforms the journal in some sense from its local ownership to the worldwide professional community and to the public.JCDR is indexed with Embase & EMbiology, Google Scholar, Index Copernicus, Chemical Abstracts Service, Journal seek Database, Indian Science Abstracts, to name few of them. Manuscriptspublished in JCDR are available on major search engines ie; google, yahoo, msn.
In the era of fast growing newer technologies, and in computer and internet friendly environment the manuscripts preparation, submission, review, revision, etc and all can be done and checked with a click from all corer of the world, at any time. Of course there is always a scope for improvement in every field and none is perfect. To progress, one needs to identify the areas of one's weakness and to strengthen them.
It is well said that "happy beginning is half done" and it fits perfectly with JCDR. It has grown considerably and I feel it has already grown up from its infancy to adolescence, achieving the status of standard online e-journal form Indian continent since its inception in Feb 2007. This had been made possible due to the efforts and the hard work put in it. The way the JCDR is improving with every new volume, with good quality original manuscripts, makes it a quality journal for readers. I must thank and congratulate Dr Hemant Jain, Editor-in-Chief JCDR and his team for their sincere efforts, dedication, and determination for making JCDR a fast growing journal.
Every one of us: authors, reviewers, editors, and publisher are responsible for enhancing the stature of the journal. I wish for a great success for JCDR."



Thanking you
With sincere regards
Dr. Rajendra Kumar Ghritlaharey, M.S., M. Ch., FAIS
Associate Professor,
Department of Paediatric Surgery, Gandhi Medical College & Associated
Kamla Nehru & Hamidia Hospitals Bhopal, Madhya Pradesh 462 001 (India)
E-mail: drrajendrak1@rediffmail.com
On May 11,2011




Dr. Shankar P.R.

"On looking back through my Gmail archives after being requested by the journal to write a short editorial about my experiences of publishing with the Journal of Clinical and Diagnostic Research (JCDR), I came across an e-mail from Dr. Hemant Jain, Editor, in March 2007, which introduced the new electronic journal. The main features of the journal which were outlined in the e-mail were extensive author support, cash rewards, the peer review process, and other salient features of the journal.
Over a span of over four years, we (I and my colleagues) have published around 25 articles in the journal. In this editorial, I plan to briefly discuss my experiences of publishing with JCDR and the strengths of the journal and to finally address the areas for improvement.
My experiences of publishing with JCDR: Overall, my experiences of publishing withJCDR have been positive. The best point about the journal is that it responds to queries from the author. This may seem to be simple and not too much to ask for, but unfortunately, many journals in the subcontinent and from many developing countries do not respond or they respond with a long delay to the queries from the authors 1. The reasons could be many, including lack of optimal secretarial and other support. Another problem with many journals is the slowness of the review process. Editorial processing and peer review can take anywhere between a year to two years with some journals. Also, some journals do not keep the contributors informed about the progress of the review process. Due to the long review process, the articles can lose their relevance and topicality. A major benefit with JCDR is the timeliness and promptness of its response. In Dr Jain's e-mail which was sent to me in 2007, before the introduction of the Pre-publishing system, he had stated that he had received my submission and that he would get back to me within seven days and he did!
Most of the manuscripts are published within 3 to 4 months of their submission if they are found to be suitable after the review process. JCDR is published bimonthly and the accepted articles were usually published in the next issue. Recently, due to the increased volume of the submissions, the review process has become slower and it ?? Section can take from 4 to 6 months for the articles to be reviewed. The journal has an extensive author support system and it has recently introduced a paid expedited review process. The journal also mentions the average time for processing the manuscript under different submission systems - regular submission and expedited review.
Strengths of the journal: The journal has an online first facility in which the accepted manuscripts may be published on the website before being included in a regular issue of the journal. This cuts down the time between their acceptance and the publication. The journal is indexed in many databases, though not in PubMed. The editorial board should now take steps to index the journal in PubMed. The journal has a system of notifying readers through e-mail when a new issue is released. Also, the articles are available in both the HTML and the PDF formats. I especially like the new and colorful page format of the journal. Also, the access statistics of the articles are available. The prepublication and the manuscript tracking system are also helpful for the authors.
Areas for improvement: In certain cases, I felt that the peer review process of the manuscripts was not up to international standards and that it should be strengthened. Also, the number of manuscripts in an issue is high and it may be difficult for readers to go through all of them. The journal can consider tightening of the peer review process and increasing the quality standards for the acceptance of the manuscripts. I faced occasional problems with the online manuscript submission (Pre-publishing) system, which have to be addressed.
Overall, the publishing process with JCDR has been smooth, quick and relatively hassle free and I can recommend other authors to consider the journal as an outlet for their work."



Dr. P. Ravi Shankar
KIST Medical College, P.O. Box 14142, Kathmandu, Nepal.
E-mail: ravi.dr.shankar@gmail.com
On April 2011

Important Notice

Original article / research
Year : 2012 | Month : September | Volume : 6 | Issue : 7 | Page : 1229 - 1232

A Comparative Study on the Superior, Supero-Temporal and the Temporal Incisions in Small Incision Cataract Surgeries for Post Operative Astigmatism

Vaishali Satyajeet Pawar, D. K. Sindal

1. Senior Resident , Department of Ophthalmology, 2. Professor & Head, Department of Ophthalmology, Krishna Institute of Medical Sciences ,Karad, Maharashtra 415110, India.

Correspondence Address :
Dr. Vaishali Satyajeet Pawar,
Senior Resident, Department of Ophthalmology,
Krishna Institute of Medical Sciences ,Karad,
Maharashtra, 415110, India.
Phone: 91-9423867394
E-mail: drvspawar269@gmail.com

Abstract

Introduction: Cataract surgery is no more a blind rehabilitation surgery. With all the possible modalities of cataract surgery, we try to give a normal vision. But Surgically Induced Astigmatism (SIA) is one of the causes of a poor quality of vision. We have studied SIA in 3 different sites of incision in Manual Small Incision Cataract Surgery (SICS).

Purpose: To compare the amount of surgically induced astigmatism after the superior, supero-temporal and the temporal incisions in manual small incision cataract surgery.

Materials and Methods: Three hundred patients were studied. The patients were randomly assigned to any of three groups. The three groups had 100 patients each. The patients in group A underwent manual SICS with a superior incision, the patients in group B underwent manual SICS with a supero-temporal incision and the patients in group C underwent manual SICS with a temporal incision. The patients were examined on the postoperative days 1,7,21 and 45. The uncorrected and the best-corrected visual acuity was recorded and a slit-lamp examination and auto-refracto-meter and keratometry examinations were also done.

Statistics: All the calculations were performed by using the Surgically-Induced Astigmatism (SIA) calculator version 2.1, a free software program. The one way ANOVA test was also applied.

Results: The mean SIA in group A was found to be 1.572 ± 0.651, in group B, it was 0.532± 0.317and in group C, it was 0.435 ±0.338 .The F score which was applied was found to be 186.44. This value was more than the standard value. The p-value accordingly was < 0.001, which was highly significant.

Conclusion: SICS which is done with a temporal and a supero-temporal approach provides a better quality of vision due to a significantly less SIA than the superior approach.

Keywords

Astigmatism, Small incision cataract surgery, Superior incision, Temporal incision, Supero-temporal incision, Surgically induced astigmatism (SIA)

How to cite this article :

Vaishali Satyajeet Pawar, D. K. Sindal. A COMPARATIVE STUDY ON THE SUPERIOR, SUPERO-TEMPORAL AND THE TEMPORAL INCISIONS IN SMALL INCISION CATARACT SURGERIES FOR POST OPERATIVE ASTIGMATISM. Journal of Clinical and Diagnostic Research [serial online] 2012 September [cited: 2019 Aug 17 ]; 6:1229-1232. Available from
http://www.jcdr.net/back_issues.asp?issn=0973-709x&year=2012&month=September&volume=6&issue=7&page=1229-1232&id=2493

Introduction
The cataract is defined as an opacity in the lens capsule or its substance. It is the commonest cause of treatable blindness . The mainstay of the management of cataract is surgery. Cataract surgery is no more a blind rehabilitation surgery. But it gives absolutely a normal vision. Today’s trend is manual Small Incision Cataract Surgery (SICS) and Phacoemulsification (Phaco) with posterior chamber intraocular lens implantation. Phaco is the most favoured method in the industrialized countries. In the developing countries like India, manual SICS is the most favoured method, as the Phaco machinery is expensive and it requires maintenance. Also, there is a steep learning curve (1). The main aim of the cataract surgery is to provide a good vision quantitatively as well as qualitatively and an early visual rehabilitation. Astigmatism means “without a point”. Miller Stephen J defined astigmatism as a condition of refraction in which a point of light cannot be made to produce a punctate image upon the retina by a correcting spherical lens (2). Astigmatism causes blurring of the images. Even with an appropriate spectacle correction, the meridonal magnification can create distortion. In all types of cataract surgeries, the incisions which are made on the cornea or the sclera give rise to scars, thus altering the curvature of the cornea. These scars cause corneal flattening along the meridian of the incision and steepening in the meridian 90% away (3). This Surgically Induced Astigmatism (SIA) is one of the causes of the poor quality of vision post-operatively because of the blurring of images. SIA in turn, depends on the type, length and the position of the incision and also on the method of the wound closure (4). Reddy et al., (2007) studied the comparison of astigmatism which was induced by superior and temporal sections in SICS in the Indian population, but their study had a smaller group of 64 patients only (5). Gokhale et al., (2005) compared astigmatism which was induced by superior, supero-temporal and temporal incisions in manual SICS (6). This study was hence undertaken to evaluate the results in a wider population group.

Material and Methods

This was a prospective, hospital based, randomized, controlled clinical study which was conducted between January 2010 - Dec ember 2011 with permission from the ethical committee of the institute. All the surgeries were conducted at the Department of Ophthalmology, Krishna Institute of Medical Sciences University,KIMS, Karad, by 2 experienced surgeons. A total of 300 patients were selected. The patients were randomly assigned to any of three groups. The three groups had 100 patients each. The patients in group A underwent manual SICS with superior tunnel incisions, the patients in group B underwent manual SICS with supero-temporal tunnel incisions and the patients in group C underwent manual SICS with temporal tunnel incisions.

Inclusion criteria
The patients with nuclear and cortical cataracts which ranged from grade 1 to hyper mature cataracts. The posterior sub-capsular cataracts were selected.

Exclusion criteria
The patients with associated glaucoma, traumatic cataract, complicated cataract, lenticular subluxation, poorly dilating pupils, previous intraocular or corneal surgeries or glaucoma surgeries, a doubtful zonular integrity due to pseudoexfoliation, corneal scarring or degeneration, macular degeneration and retinal pathology and those with intra-operative, post-operative complications were excluded.

METHODS
All the patients were pre-operatively assessed with visual acuity recording, slit-lamp bio-microscopy, tonometry and fundus examination by using a direct and indirect ophthalmoscope and 90 D or 78 D. Astigmatism was measured by using a autorefractometer and a keratometer if it was possible. The IOL power was calculated by contact A-scan biometry by using the SRK II formula. Pre-oerative investigations like a complete haemogram, random blood sugar, routine urine and microscopy were done. Topical ofloxacin 0.3 % eye drops were instilled four times a day, three days before the surgery. A pre-operative informed consent was taken from the patients. Topical tropicamide 0.8% with phenylepherine 5% and flurbiprofen (non-steroidal anti-inflammatory) eye drops were instilled every 15 minutes, 1 hour before the surgery. The patients were operated under peribulbar anaesthesia with 5 cc of a 3:2 mixture of injection Xylocaine 2% and Injection bupivacaine 0.5 % with 150 I.U. of Hyaluronidase.

A conjunctival flap was made. A 6 mm frown shaped scleral incision which was 1.5 mm posterior to the limbus was made. In group A, the incision was made superiorly (Table/Fig 1), in group B it was made supero-temporaly (Table/Fig 2) and in group C, it was made temporally (Table/Fig 3). A three-plane sclero-corneal tunnel was created with a 15 No. blade and a crescent blade. Through a side port, the anterior chamber was filled with Trypan blue. After 30 seconds, the anterior chamber was washed and filled with a viscoelastic solution (Hydroxy Propyl Methyl Cellulose 2%). Capsulorrhexis was performed by using a 26 gauge needle. An entry into the anterior chamber was made with a sharp 3.2mm keratome to create a self sealing corneal valve and the internal opening was extended with the same keratome up to 7 mm, which was slightly larger than the external one. Hydro-dissection and delineation were performed. The upper pole of the nucleus was prolapsed out of the capsular bag. Through the scleral tunnel, the nucleus was delivered directly by visco-expression. The cortical matter was aspirated with simcoe two way irrigation and aspiration cannula. In the presence of a viscoelastic solution, a rigid posterior chamber 6×12.5 mm PMMA intraocular lens was implanted in the posterior chamber. The visco solution was removed from the anterior chamber by irrigation with ringer lactate by using a simcoe cannula. A corneal stromal hydration was performed at the wound edges. A sub-conjunctival injection, Gentamicin 20 mg mixed with Dexamethasone 2mg was injected in the lower fornix. The eye was bandaged for 24 hours. Post-operatively, oral antibiotics (Tab.Ofloxacin 200 mg twice daily) and analgesics were given. The patients were examined on the post-operative days 1,7, 21 and 45 . The uncorrected and the best corrected visual acuity were recorded; slit-lamp examination, fundus examination and autorefractometer and keratometry examinations were done. A topical antibiotic – steroid combination eye drop (Ofloxacin 0.3%- Dexamethasone 0.1%) was instilled every 2 hourly for the first 7 days in the operated eye and then in tapering doses over a period of 45 days. Proper eye care was advised to the patients to prevent eye infections, like hand washing, proper instillation of the eye drops and avoidance of coughing and lifting heavy weights. The patients were asked to come for regular follow ups. All the calculations were performed by using the surgically induced astigmatism (SIA) calculator version 2.1, a free software program (7). The Surgically Induced Astigmatism was calculated from the pre and the postoperative keratometric values, as was described by Holladay et al., (8). The comparison between the groups was done by using InStat (a statistical software program) in steps like comparing the means and performing the ordinary ANOVA test and the assuming values were sampled from the Gaussian distribution.

Results

A total of 300 eyes were operated on. There were 100 eyes in each group. The age distribution of the patients in the different groups was as has been shown in (Table/Fig 4). The sex distribution of the patients in the different groups was as has been shown in (Table/Fig 5).The mean SIA in group A was found to be 1.572 ± 0.651, in group B, it was 0.532± 0.317 and in group C, it was 0.435 ±0.338 (Table/Fig 6).The F score which was applied was found to be 186.44. This value was more than the standard value.

One way Analysis of Variance (ANOVA) with post tests showed a p value of < 0.0001, which was highly significant. The mean of the variation among the groups was significantly greater than that which was expected by chance (Table/Fig 7). The Bartlett’s statistics was 67.490 and so, p was < 0.0001. This suggested that the difference between the standard deviations was extremely significant.

Discussion

The sutureless manual Small Incision Cataract Surgery (SICS) is a good alternative to Phacoemulsification and it gives visual results which are equivalent to Phacoemulsification, at lower expenses. But the rates of astigmatism are higher due to the larger sizes of the incisions. In order to achieve an excellent visual acuity, the effect of astigmatism on the postoperative vision has to minimize. Burgansky et al have reported an increase in astigmatism with an increase in the incision size (9). A pre-existing astigmatism can be neutralized by changing the site of the incision. When the incision is located superiorly, both the gravity and the blinking of eyelid tend to create a drag on the incision. These forces are neutralized better with temporally placed incisions because in such cases, the incision is parallel to the vector of the forces (10). But a superior incision is easy to learn and the upper eyelid covers the incision and so the wound is protected and the foreign body sensation is less. The temporal location is the farthest from the visual axis and any flattening which is caused by the wound is less likely to affect the corneal curvature at the visual axis. A temporal incision is advantageous because it can be made easily in deep sockets and small eyes. Also, the superior site is still there if a trabeculectomy surgery has to be done for glaucoma in the future. But it is difficult to learn and the upper lid does not cover the incision and so the foreign body sensation due to the exposure is more and it is exposed to infection.

The supero-temporal location has the advantages of both the locations. The supero-temporal incision is free from the effect of gravity and eyelid pressure and it tends to induce less astigmatism. The astigmatism which was induced in manual SICS which was done with superior, supero-temporal and temporal scleral tunnel incisions was compared. This study found that the induced astigmatism was lower in the temporal and supero-temporal groups as compared to that in the superior group. The astigmatism in the supero-temporal and the temporal groups was comparable. In the study of Gokhale et al., (2005), the SIA in the superior group was 1.28D, it was 0.2D in the superotemporal group and it was 0.37D in the temporal group (6). Our study also showed similar results, with the superior group having an SIA of 1.57D, an SIA of 0.53D in the supero-temporal group and that of 0.435D in the temporal group.

Conclusion

SICS with the superior-temporal and the temporal approaches provides a better quality of vision due to the significantly less SIA than the superior approach. But the supero- temporal incision has the advantages of both the locations and so it is better than the temporal incision.

References

1.
Minnassian DC, Rosen P, Dart JK, Reidy A, Desai P, Sindhu M. Extra capsular cataract extraction compared with small incision surgery by phacoemulsification: a randomized trial. Br J Ophthalmol 2001; Jul; 85(7); 822-29.
2.
Miller SJ, Parson’s Diseases of Eye. Edinburgh: Butterworth Hienmann International Edition. 18th edition 1990; 63-69.
3.
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