RESEARCH ARTICLE CLINICAL OUTCOME OF CATARACT EXTRACTION BY EXTRA CAPSULAR CATARACT EXTRACTION AND PHACOEMULSIFICATIO IN GOVERNMENT MEDICAL COLLEGE, SRINAGAR, KASHMIR, INDIA

Background:- To compare phacoemulsification with extracapsular cataract surgery in patients with diabetes and to identify determinants of posto perative visual acuity. Design:- Prospective, randomized, paired-eye trial. Participants:- Seventy patients with diabetes and bilateral cataract. Intervention:- Patients were allocated to phacoemulsification surgery with silicone intraocular lens to one randomly determined eye, and extracapsular cataract surgery with 7 mm polymethylmethacrylate intraocular lens to the other. Main Outcome Measures:- Logarithm of minimum angle of resolution visual acuity (logMAR VA), incidence of clinically significant macular edema (CSME), retinopathy progression, indices of anterior segment inflammation, and incidence of capsulotomy. Results:- Compared to Extra Capsular Cataract Extraction(ECCE), Phacoemulsification group showed improvement in visual acuity right from 1st week and at 6 month, most of the Phacoemulsification group (68.6%) had uncorrected visual acuity of 6/12 or better. Signs of inflammation (cells, flare, IOL depo sits, synechiae and posterior capsule opacification) were seen more often in ECCE group. Six number of patients required Nd -YAG Laser Capsulotomy in total, one in Phacoemulsification group and 5 in ECCE group. Phacoemulsification group showed slightly more incidence of corneal oedema and striate keratopathy than ECCE group. Progression of retinopathy was determined by the presence or absence of diabetic retinopathy at the time of surgery, duration of diabetes and the type of medication received. Age and hypertension had no relation with the progression of diabetic retinopathy. No effect of operative technique on progression of retinopathy or incidence of post operative CSME was demonstrated. Conclusion:- Phacoemulsification is better technique as there is l ess postoperative inflammation and better visual outcome compared to ECCE especially in eyes with retinopathy.