Comparison of changes in endothelial cell count and central corneal thickness after phacoemulsification and small-incision cataract surgery: A prospective observational study at a tertiary care center of eastern Uttar Pradesh

PURPOSE: Morphological stability and functional integrity of corneal endothelium are necessary to maintain long-term corneal transparency. When the number of endothelial cells drops below 450–800 cells/mm(2), corneal edema, irreversible loss of corneal transparency, and decreased vision occur. There is concern regarding manual small-incision cataract surgery (MSICS) being more harmful to the endothelium in comparison to phacoemulsification. Our study aims to determine which technique maintains the corneal parameters closest to the normal physiological state. METHODS: A prospective observational study was conducted over a period of 15 months on 100 eyes, out of which 43 patients underwent phacoemulsification surgery and 57 underwent MSICS. TOPCON SP-1P, Version 1.41, 50–60 Hz frequency, noncontact specular microscope with pachymeter was used to measure endothelial cell count (ECC) and central corneal thickness (CCT) on four occasions: 1 day prior to surgery and on day 1, 3(rd) week, and 6(th) week after surgery. RESULTS: In total, 100 eyes of 100 subjects were studied with no dropout during the study period. The age range was 40–70 years. There was no statistically significant difference between the preoperative mean ECC and mean CCT in phacoemulsification and SICS groups. A statistically significant difference was observed in the postoperative mean ECC (P < 0.01) and mean CCT (P < 0.001) on day 1 and 3(rd) week between the phacoemulsification and SICS groups, respectively. The mean endothelial cell loss at 6 weeks was less with SICS but comparable with phacoemulsification. CONCLUSION: SICS is significantly faster, less expensive, less technology dependent, can deal with all types of cataracts, is relatively safe, and is more appropriate for advanced cataracts.