Aim: To evaluate the visual outcome in grade IV nuclear cataract after small incision cataract surgery.

Materials and Methods: A prospective study of 100 patients with grade IV nuclear cataract (grade IV) were reviewed. All patients underwent small incision cataract surgery with effective technique of minimal hydrodissection and copious viscoelastic usage. The surgical techniques used, intraoperative complications, preoperative and postoperative visual acuity and the causes of impaired visual acuity after surgery were examined.

Results: Among 100 patients, majority of the patients were from 61-70 years age group (i.e., 52%), mean age of the study population was 65.42 +/- 8.56 years, males were predominant in our study with male to female ratio as 1.71:1. Intraoperative complications included iris injury (2%), posterior capsular rent (3%), aphakia (3%), post operative complications included epithelial edema (5%), stromal edema (6%), anterior chamber reaction (5%), iritis (5%). Snellen’s visual acuity on day 1 was > 6/18 in 85% cases, and after one week was> 6/18 in 90% cases. BCVA after 6 weeks was >6/18 in 98% cases.

Conclusion: Visual outcome in patients with grade IV nuclear cataract is good when surgery done after proper pre-op assessment, with thorough planning. Experienced surgeons with proper knowledge of the technique during the surgery.

Keywords: BCVA; Grade IV nuclear cataract; Intraoperative complications; SICS; Visual outcome.