Hands-on Training Programs

Manual Small Incision Cataract Surgery

Extra-capsular cataract surgery is currently the preferred method of lens extraction. The classical extra-capsular technique necessitates making a large incision in the eye
that requires several sutures; visual rehabilitation takes about six weeks. On the other hand, self-sealing Small Incision Cataract Surgery (SICS) offers several advantages, including earlier visual rehabilitation and more safety.

While there is a welcome shift towards small incision surgery with all its attendant advantages, the emphasis is on phacoemulsification. This technique allows cataract surgery to be done through a small incision that is stable and usually sutureless. This implies quicker patient mobilization, minimal induced astigmatism and early visual rehabilitation. These clear advantages have established phacoemulsification as the standard method for cataract surgery in industrialized nations.

Phacoemulsification is not the only method for performing SICS. Manual small incision techniques for cataract surgery are also available and may be more suitable for developing countries. Manual techniques like the phaco section can be performed through smaller incisions, most manual methods require 5.5 mm or larger incisions. The major advantage of phacoemulsification over manual techniques, therefore, is the ability to implant a foldable lens through a 3.5 mm incision. Phacoemulsification is an expensive, machine-dependent technique that requires considerable investment and recurrent expenses. Compared to a manual small incision, the eventual advantage of a foldable IOL through a 3.5 mm incision is a 0.3D reduction in induced astigmatism. This advantage has to be weighed against the costs involved in doing phacoemulsification with a foldable lens.

Especially in a developing country like India where 51 percent of all blindness is because of cataract, the benefits of a paradigm shift to SICS are justifiable as it offers early visual rehabilitation, less chances of surgical astigmatism and better uncorrected visual acuity as compared to ECCE - and at a lesser cost when compared to phacoemulsification.

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