EVALUATION OF CAUSES OF EARLY POSTOPERATIVE HYPHEMA IN MANUAL SMALL INCISION CATARACT SURGERY.

Background: Cataract surgery is the most commonly performed surgery in the world. Manual small incision cataract surgery (MSICS) is principally employed in resource poor settings and bulk of cataract surgeries are performed by this technique in the developing world. Results achieved by MSICS is comparable with phacoemulsification in achieving excellent visual outcomes with low complication rates. Hyphema is one of the common postoperative complication of MSICS. Aim: To estimate the incidence and evaluate the causes of early postoperative hyphema in MSICS. Design: Cross sectional observational study done on hospital based patients who underwent manual small incision cataract surgery between August 2019 and July 2020. Material and methods: The demographic data, operation notes and details of clinical examination done using slit lamp bio microscopy on the first postoperative day of 341 patients who underwent MSICS between August 2019 and July 2020 were obtained from the hospitals clinical medical records section. Surgical technique of wound construction and its relevance to the incidence of postoperative hyphema on the first postoperative day was analysed. Results: Out of 341 patients, 26 (7.6%) had hyphema on first postoperative day. The variation in the surgical technique and other causes that was frequently associated with postoperative hyphema were in the order as extension of the wound, deep tunnel, posterior incision site, premature entry and iridodialysis. In 3 patients we could not attribute hyphema to any known cause. Conclusion: A proper technique of wound construction helps avoid this potential complication and thus refinement goes a long way in keeping up the morale of the MSICS surgeon.