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Manual Cataract Refractive Surgery
 
Dr Sudhir Singh, MS
Sr. Consultant & Head
Department of Ophthalmology
JW Global Hospital Research Centre
Mount Abu India 302019
drsudhirsingh@gmail.com 
 

Video With Commentary :  Neutralizing pre existing corneal astigmatism (Toricity) by planning cataract surgery incisions without toric IOLs.
 

 Introduction

Intratunnel phacofracture technique is a new technique of the manual small incision cataract surgery (MSICS).In this technique nucleus is broken inside the 4 to 6 mm wide sclero-corneal tunnel with the help of the Lewis lens loop. The surgical induced astigmatism (SIA) depends on incision size, shape and site of the cataract surgery incisions. The SIA of 4 mm to 8 mm sclerocorneal tunnel incision varies from 0.50 D to 3.00.The cataract surgery incisions are planned such a way that can neutralize pre existing corneal astigmatism by SIA without the costly toric IOLs. So manual cataract surgery is also manual cataract refractive surgery.The Intratunnel phacofracture technique was innovated by Dr Sudhir Singh1,2.

Principles of the Manual Cataract Refractive Surgery
Manual Cataract Refractive Surgery is based on following principles:

1.Neutralizing pre existing corneal astigmatism (Toricity) by planning cataract surgery incisions without toric IOLs.

2.Surgical induced astigmatism (SIA) Induced multifocal vision by monofocal IOL

 

Surgical Induced Astigmatism (SIA)
Post surgery astigmatism is produced by incisions called as surgical induced astigmatism (SIA). SIA is related to  incision size, shape, location. The amplitude of the SIA  produced by intratunnel phacofracture is given table 1.
Pre operatively most of the corneas have pre existed astigmatism (PEA) of various amplitude.This PEA is effectively neutralized simply choosing incision size and site (Table 2).On the contrary in phacoemulsification we require costly toric intra ocular lenses

 

Table 2:Pre pre existed astigmatism neutralizing incision normogram

 

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Surgically Induced Astigmatism (SIA) Induced Multifocal Vision By Monofocal IOL
 If surgical induced astigmatism is planned such a way that there is a simple myopic astigmatism of -0.75D to -1.25D vertical axis or compound myopic astigmatism of -0.25 D Sph -1.00 Cyl at vertical axis or compound myopic astigmatism of -0.50 D Sph -0.75 Cyl at vertical axis or mixed astigmatism of +0.50 Sph -1.25 Cyl vertical axis gives multifocal vision by a monofocal IOL(Image1}.This SIA induce  multi focal vision free from side effects of the multifocal IOL like halos, ghost images. So it eliminate the side effects and heavy cost of the multifocal.

Image 1:SIA induce  multifocal vision illustration

Video Cases

 
References
1.Singh S. First postoperative day visual outcome following 6 mm manual small incision cataract surgery using intratunnel phacofracture technique. US Ophthalmic Review. 2014;7(1):26-30.
2.Singh Sudhir. Step-by-step: Intratunnel Phacofracture. Cataract & Refractive Surgery Today Europe | MAY 2016:48-51
Intratunnel Phacofracture Manual Small Incision Cataract Surgery (MSICS) Video

How To Plan Incisions In MSICS
 
4 mm Intratunnel Phacofracture Manual Small Incision Cataract Surgery (MSICS) Video

 

Intratunnel Phacofracture Technique  In Difficult Cataracts Cases Scenario

 

Manual Small Incision Cataract Surgery (MSICS or Manual SICS) Video

 

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Important Links
Cataract
 
Cataract Surgery In Small Pupil : No Hooks No Rings NEW
Difficult Cataract Cases Scenario Made Easy NEW
 
 
 
 
 
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