Improving the Outcomes of Modified Manual Small Incision Cataract Surgery Using Clinical Audit

Purpose:  To use clinical audit in improving the outcomes of manual small incision cataract surgery technique Study Design:  Clinical audit. Place and Duration:  Layton Rehmatullah Benevolent Trust Eye hospital Karachi, from September 2019 to December 2019. Methods:  Two hundred patients who had undergone Manual Small Incision Cataract surgery were selected. Cases with traumatic cataract, weak zonules, pseudoexfoliation, and more than 1 diopter difference in keratometric readings, corneal and retinal pathologies were excluded. Surgical complications and visual outcomes were recorded on the 7th postoperative day. Refractive data was recorded from subjective refraction. Data was analyzed by University Hospital Bristol formula. Standards were set using international literature. Deficiencies were noted and technique was modified to improve the outcome. The audit was repeated after 2 months to see whether modifications had improved the outcome. Results:  In the first audit, posterior capsular rupture rate was 1%, corrected visual acuity of 6/12 or better was achieved in 85.36% and surgically induced cylinder of less than 2 DC was achieved in 75.60% of the patients. In the second audit all standards were achieved. Posterior capsular rupture did not occur. Corrected visual acuity of 6/12 or better was achieved in 90.50% and induced cylinder of less than 2 DC was achieved in 87.05% of the patients. Conclusion:  Clinical audit of the surgical procedures is a good technique in improving the outcomes of manual small incision cataract surgery. Key Words:  Cataract extraction, clinical audit, posterior capsular rupture, astigmatism, visual acuity.