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Age-related cataract is the major cause of vision loss in developing countries and across the globe.[1] One of the most known treatments for cataract surgery is SICS. According to National Program for Control of Blindness and Visual Impairment (NPCB&VI) data, the average cataract surgery rate in the last five years is approximately 6.4 million per year, making it most cost? effective technology that provides the best visual rehabilitation [2]. Continued research, advances in surgical techniques, development and modification of instruments, and newer pharmacological advancements have revolutionized cataract surgical management.[3] The surgery has evolved from extracapsular cataract extraction (ECCE) to manual small-incision cataract surgery (MSICS) and phacoemulsification. Unfortunately, the most common undesirable side effect of cataract surgery is corneal endothelial cell loss, which may affect postoperative visual outcomes.[4] Corneal endothelial cells are monolayer of polygonal cells. The average density of corneal endothelial cells in adults is around 2000-3000 cells /mm3. The endothelial cell of cornea comprises of ionic pump which helps to maintain stromal hydration. If the pump function is compromised the thickness of cornea will increase and further affect the transparency. [5] Endothelial cell loss during surgery is influenced by various preoperative and intraoperative factors. This is of particular concern as endothelial cells do not regenerate and cellular decline below 1000 can lead to corneal decompensation. [6] Endothelial damage during phacoemulsification has been associated with mechanical injury, which correlates with ultrasonic power and total time.[7] Short axial length, shallow anterior chamber depth (ACD), dense cataract, incision size, irrigating solutions, ocular viscoelastic devices (OVD), and type of intraocular lens (IOL)are other factors known to affect corneal endothelial cell density.[8] Ocular viscoelastic device is substance required for protection of the corneal endothelium and to facilitate surgery. If the viscoelastic device is not washed properly from the anterior chamber, it could cause an inflammatory response accompanied by a raised intraocular pressure. This could have a depletory effect on the corneal endothelial cells.[9] Anterior chamber maintainer Commonly used irrigating solutions during cataract surgery are Ringer’s lactate (RL) solution. Balanced salt solution is composed of potassium, calcium, lactate and magnesium (essential for the Mg-ATPase endothelial pump) and an acetate citrate buffer system. It is slightly hypotonic to the aqueous fluid and has an alkaline pH. [10] Thus, this study is to review and establish evidence pertaining to endothelial cell count, central corneal thickness and intraocular pressure in manual small incision cataract surgery using viscoelastic hydroxy propyl methyl cellulose vs anterior chamber maintainer using balanced salt solution. Thus, in turn helping us to select desirable method of performing manual small incision cataract surgery to prevent excess endothelial cell count loss.
