The purpose of this study is to determine the percentage of difficult cataracts out of total cataracts admitted in a tertiary care center, to study the intra and postoperative complications in patients with difficult cataracts undergoing cataract surgery, and to determine their visual outcomes. This was a retrospective, non comparative, single institutional, observational study.

The patients with difficult cataracts (according to inclusion criteria) were screened and preoperatively evaluated. These patients underwent manual small incision cataract surgery and were followed up on the 1st, 7th, and 40th postoperative days and monitored for postoperative visual acuity (VA) and complications.

Of 3844 patients, 1114 (28.9%) patients presented with difficult cataracts. Hypermature and mature cataracts, hard cataracts, and pseudoexfoliation constituted as the major causes. Of these, 492 (44.1%) patients presented with no complications postoperatively. The most common postoperative complication was corneal edema (39.3%). A total of 21.7% had VA <6/60 on postoperative day 1, which reduced to 5.06% on day 40 (P < 0.001). The patients with V/A >6/18 increased from 44.4% on day 1 to 62.3% on day 40 (P < 0.001). Visual morbidity remains high among patients with difficult cataracts, especially in patients with pseudoexfoliation and corneal pathology.

Keywords: Corneal degeneration, difficult cataract, hypermature cataract, pseudoexfoliation, zonular dialysis.

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Dr Surraya Ismail Parray

Registrar, Department of Ophthalmology, GMC, Srinagar, 190010, India

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