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
