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

 Introduction

Many surgeons would go for phacoemulsification but it would prone to phaco ultrasound energy related corneal complications, lens capsule and zonules related complications including lens matter drops or zonular dialysis. In other words standard phaco would be challenging and risky despite of best of the phaco machines, OVD and surgical skills.

In such cases the role the femto laser assisted cataract surgery (FLACS) is advocated to minimize ultrasound energy related complications. The FLACS is unaffordable to most of the cataract surgeons and patients in the present scenario.

Other par excellence, simple and economical option is manual small incision cataract surgery (MSICS).
Why All Cataract Surgeon Should Learn Manual SICS
 

 

 

6 mm Intratunnel Phacofracture MSICS in Jet Black Hard Nuclear Cataract
Hard nuclear cataracts along with morbid pupil and capsular support pose problems to the best of phaco surgeons equipped with high end phaco machines and expensive OVDs. They are prone to ultrasound energy related complications; posterior capsule related complication and nucleus drop related complication. In cases manual small incision cataract surgery is the savior. We are going share a case of grade 6 large nuclear cataract, pupil not getting dilated, capsule was fibrosed and zonular support was poor. This was managed by 6 mm intratunnel phacofracture MSICS. HPMC 2% as viscoelastics and Ringer’s Lactate as irrigation solutions were used.

 

 
Intra tunnel Phacofracture SICS in Rock Hard Nuclear Cataract
Phaco in such cases may be risky even best of the surgeons equipped with high end phaco machines and expensive OVD. They are prone to ultrasound energy related complications; posterior capsule related complication and nucleus drop related complication. In such cases manual small incision cataract surgery is the savior. Learn MSICS…. It’s simple, safe, reproducible and visual outcome is better in complicated cataract.
 

 

 
MSICS In Nuclear Cataract Grade 5: First Post Op Day Clear Cornea with 6/9 Unaided Vision
MSICS In Nuclear Cataract Grade 5: First Post Op Day Clear Cornea with 6/9 Unaided Vision
This was a 70 years old gentleman presented with grade 5 nuclear sclerotic cataract with poor zonular support. Many surgeons would go for phacoemulsification but it would prone to phaco ultrasound energy related corneal complications, lens capsule and zonules related complications including lens matter drops or zonular dialysis. In other words standard phaco would be challenging and risky despite of best of the phaco machines, OVD and surgical skills.
In such cases the role the femto laser assisted cataract surgery (FLACS) is advocated to minimize ultrasound energy related complications. The FLACS is unaffordable to most of the cataract surgeons and patients in the present scenario.
Other par excellence, simple and economical option is manual small incision cataract surgery (MSICS).
We decided to do MSICS in this case. The capsulorhexis was done and two relaxing incision were made as nuclear size anticipated large. The nucleus was tried to rotate in the capsular bag bit it could not be due to capsulo-cortical matter adhesions. The cortical matter aspirated by IA canula and then nucleus is rotated and dialed out in the anterior chamber. Then nucleus was taken out by vectis. Irrigation aspiration is done. PMMA IOL implanted. The sclero-corneal tunnel was sutured with 10-0 nylon suture to control surgical induced astigmatism. Post operative day 1 vision was 6/9 unaided with crystal clear cornea.Patient had 6/6 unaided vision on 4th day post operative.
Visco used: HPMC 2 %
Irrigation Solution: Ringers Lactate
Biometry:contact US A Scan
IOL Power Formula: SRK 2
 
 
Management of Grade 4 Nuclear Cataract with Non Dilating Pupil
 This was a 75 years old gentleman presented with grade 4 nuclear cataract with non dilating pupil with floppy iris. I have three options 1. Hooks as pupil stretching devices with phacoemulsification : This approach requires 4 more extra incisions along with Phaco ultrasound energy related corneal complications, lens capsule and zonules related complications including lens matter drops or zonular dialysis'
2. Pupil expending devices and phacoemulsification : Many surgeons adopt this approach but its not free from Phaco ultrasound energy related corneal complications, lens capsule and zonules related complications including lens matter drops or zonular dialysis.
3. Manual capsulorhexis under pupillary margin with SICS :In this case we are going to use this method. The capsulorhexis was attempted under pupillary margin. The capsulorhexis was successful if not then I would proceed for can opener capsulotomy. The nucleus dialed out in the anterior chamber after hydro dissection. Then nucleus was taken out by vectis. Irrigation aspiration is done. PMMA IOL implanted. Post operative day 1 vision was 6/9 unaided with crystal clear cornea.6/6 Unaided vision 4th day post operative
 

 

 
6 mm Intratunnel Phacofracture Manual SICS In Hard Nuclear Cataract

 

 
4mm Intratunnel Phacofracture MSICS in White Cataract With Foldable IOL

 

 
Intra Tunnel Phaco Fracture (ITPF) SICS In Rock Hard Nuclear Cataract

 

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