الفهرس 
IntroductionOnly 14 pages are availabe for public view
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Abstract
In this study 30 eyes with white cataract were selected from patients attending at Mansoura ophthalmic center for cataract surgery. selection was after careful history taking and complete ophthalmic examination. The selected patients were equally classified into two groups undergone cataract extraction. Each consists of 15 patients: group A: in which phacoemulsification surgery was done using The Oertli catarrhex phaco machine. group B: in which manual small incision surgery was done. All eyes were operated by the same surgeon, same phaco machine for phaco group and same IOL type for each group. Any case with intraoperative complications as (failed CCC, posterior capsule rupture and vitreous loss) was excluded from the study. Post-operative follow up was done to all patients at 1 day, 1 week, 1month and 3months. This included careful ophthalmic examination, Pentacam and specular microscopy imaging. Data of cases from both groups were recorded like: Age, type of white cataract, pre-operative CCT, ECD and post-operative BCVA, corneal astigmatism, CCT, ECD after 1 week, 1 month and 3 months. They were collected, tabulated and statistically analyzed. Results in this study showed that there was statistically highly significant difference between the phaco and MSICS groups in the endothelial cell density and no statistically significant difference in visual acuity, corneal astigmatism and central corneal thickness. As regard ECD, there was statistically highly significant endothelial cell density throughout the study in the two groups as compared to preoperative values, highly significant difference between the two groups was recorded (P> 0.001). In the phaco group, the ECD decreased from (2605.20 ± 259.20 cell/mm2) to (1918.53 ± 328.91 cell/mm2) at 1week post-operative, then increased to (2119.80 ±264.33 cell/mm2 ) at 1month post-operative and more increase (2312.13 ± 242.72 cell/mm2) at 3months post-operative with cell loss about 9.09% . In the MSICS group, the ECD decreased from (2784.13 ± 218.25 cell/mm2) to (2419.73 ± 247.44 91 cell/mm2) at 1week post-operative, then increased to (2548.33 ± 223.0333 cell/mm2) at 1month post-operative and more increase (2666.13 ± 198.18 cell/mm2) at 3 months post-operative with cell loss about 3.62%. As regard means CCT, there was statistically significant increase in both groups as compared to preoperative values. The most significant increase was equal in both groups at 1week post-operatively from (516.93 ± 19.29µm) to (555.87± 18.35µm) in the phaco group and from (523.87 ± 33.07µm) to (554.60 ± 31.06 µm) in the MSICS group. After 1month there was less increase in mean CCT in both groups and least increase was after 3months (about 1.5% in phaco group and 0.38% in MSICS group as compared to pre-operative mean CCT). Although more increase in mean CCT occur in phaco group when compared to MSICS group difference was statistically insignificant (P = 0.110). As regard visual acuity , both techniques gave excellent visual results with no statistical difference (P=0.139) of both the phacoemulsification group and the MSICS group attained mean BCVA 0.18 ± 0.07 D and 0.15 ± 0.06 D respectively at the three-month follow-up visit. As regard corneal astigmatism, at the three-month follow up visit was (1.19 ± 0.93 D) in phacoemulsification group while (1.60 ± 1.12 D) in MSICS group. Although more increase in the corneal astigmatism occur in MSICS group when compared to phaco group difference was statistically insignificant (P = 0.262). As regard k reading, k1 which is the curvature power of the flat meridian of the anterior surface of the cornea measured within the 3-mm central zone and expressed in diopters was significant in both groups at 3 months post-operative as compared to preoperative values with no statistical significant difference between the both groups (P=0.754), K2 which is the curvature power of the steep meridian of the anterior surface of the cornea measured within the 3-mm central zone and expressed in diopters was insignificant in both groups along the study period (P=0.818). Conclusions White cataract surgery using phacoemulsification caused slightly more endothelial cell loss than manual small incision cataract surgery. Phacoemulsification and MSICS achieve comparable and excellent visual outcomes in dealing with white cataract. MSICS isn’t superior to phacoemulsification but it has similar advantages and is affordable, So it is a good alternative to phacoemulsification in developing countries to manage the white cataract. So, it is very important to master MSICS either for beginners to be like a step for learning phacoemulsification later on or even for expert surgeons who already master phacoemulsification to be like an extra weapon if they need to convert during surgery to get much better results than extra-capsular cataract extraction or to be their first choice in cases of white cataract. However, this study is limited by a small sample size of white cataract of operated eyes. Nevertheless, the findings have meaningful clinical relevance to support the efficiency and safety of MSICS in white cataract management.