ABSTRACT
Manual small-incision cataract surgery (MSICS) is a cost-effective alternative to phacoemulsification and extracapsular cataract extraction (ECCE) for cataract surgery. The surgical technique in MSICS is heterogeneous, and the maximum variation exists in incision and nucleus delivery techniques. Many studies on various incisions are available, and most of them are dedicated to surgically induced astigmatism (SIA), utility, and visual outcomes. The nucleus delivery techniques have less-extensive literature available. They can be divided into 損ulling� techniques like phacosandwich technique, fish hook technique, and vectis delivery and 損ushing� techniques like viscoexpression or hydroexpression with irrigating vectis/Blumenthal抯 MiniNuc technique. Postoperative surgical-induced astigmatism is comparable in all techniques. The authors describe a pushing technique which does not raise the pressure of the anterior chamber and can be utilized with variable-sized and irregularly shaped nuclear fragments. It has universal application, especially when the size of the incision is getting smaller in MSICS and phacofragmentation is being used as an adjunct to reduce the incision size. It can be used in situations like posterior polar cataracts, where pressure variations in the anterior chamber can be dangerous.
ABSTRACT
Manual small-incision cataract surgery (MSICS) has existed as an alternative to conventional phacoemulsification since its inception. The size of the incision has been becoming smaller in MSICS to reduce the surgically induced astigmatism. Smaller incisions go hand in hand with nucleus debulking and fragmenting techniques which have been practiced over almost four decades. Such techniques have a learning curve and require meticulous execution. The authors describe a technique to achieve nucleus bisection or trisection or debulking in a closed anterior chamber. This technique has been in use for a long time; it has shown excellent results and has a shorter learning curve. Since it is done in a closed chamber, the risk to the corneal endothelium is minimized as the anterior chamber remains deep throughout the procedure. Sudden escape of the viscoelastic and shallowing of the chamber are prevented, and the corneal endothelium is well protected. It uses iris as support and reference. The specially designed chopper is an inexpensive addition to the instruments. Fragmentation is achieved in the proximal half of the chamber where control over instruments is maximum. Pristine clear cornea on day 1 is the rule rather than the exception with this technique. This is a safe and repeatable technique for phacofragmentation in cataract extraction
ABSTRACT
Advanced instrumentation and intraocular lenses (IOL) allow great refractive and visual outcome control to permit excellent correction of refractive aberrations. Residual astigmatism can be modified to provide depth of focus using an appropriate incision in the steepest meridian in manual small-incision cataract surgery (MSICS). The authors describe the nomogram for surgically correcting astigmatism (SCA). This technique can handle preoperative astigmatism of about 2.25 DCyl with the standard incisions梥traight incision of 5, 6, and 7 mm in length, the minimally curved frown incision, the frown incision, the frown incision with an accentuated frown, and the U incision placed on the steep axis in the superior or the temporal quadrant depending on the axis of pre-operative astigmatism.