RESUMEN
We describe a surgical technique for manual small-incision cataract extraction with 2-mm chord incision with phacofracture. The authors describe a curvilinear 2-mm chord incision 1.5 mm behind the limbus and antiparallel to the limbus with back cuts of variable length; 1.5 mm for foldable lenses and 2.5�mm for the rigid nonfoldable lenses. Continuous curvilinear capsulorhexis with a 26-G bent needle cystitome (or Utrata forceps) is followed by cortical cleaving hydrodissection and cartwheeling of the nucleus into the anterior chamber. A specially designed Sahu modified vectis (SMV) and a flattened visco cannula are used for the phacofracture. The heminuclei are removed along their longitudinal axis and direct implantation of the pseudophakos. Surgically induced astigmatism was found to be a mean change in astigmatism of 0.14 DCyl when the axis was ignored. Corneal endothelial counts were not vastly different from the routine manual small-incision and phacoemulsification at 3 months of follow-up. The technique used here by the surgeon for cataracts of any C (1� or any P (1� to grade NC4 NO4 as graded by the LOCS III. Case selection is of paramount importance. Two-millimeter chord MSICS with phacofracture can deliver low astigmatism and good visual recovery in cataract surgery.
RESUMEN
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.
RESUMEN
Cataract surgery is constantly evolving with new techniques, machines, and procedures entering the lexicon. With the modernization, the cost of surgery is increasing with respect to the surgeon, patient, and the society. Early rehabilitation with modern minimal access techniques reduces the societal cost of intervention. Manual small-incision surgery is simple, safer, and cheaper when contrasted with the cost and steep learning curve of machine-driven surgeries. A nucleus of a normal size is 6 mm, which can be bisected; 3 mm longitudinal fragments can be removed through 3.5 to 4.5 mm incision, and a large nucleus of 9.0 mm can trisected and removed through 3.5 to 4.5 mm. The limbal tunnel incision is 3.5 mm, which is close to 2.8 mm phacoincision, so it gives all the advantages of modern phacosurgery. The search of an ideal technique for manual phaco-fragmentation leads us to this specially designed snare (designed by the first author AS) which can tackle any grade nucleus. The nucleus can be bisected or trisected with ease. The technique has been around for 2 decades. There is a small learning curve. The complications are few and can be minimized with practice and simulation. It is a safe, valid, repeatable, and generalizable surgical procedure.
RESUMEN
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
RESUMEN
A posterior polar cataract is a discoid posterior polar plaque-like cataract with a thin and fragile to absent posterior capsule with adherent acellular opacity to the capsule reported in the literature. It is a stationary or slowly progressive opacity. A higher risk of complications such as posterior capsular tear and nucleus drop makes this a challenging surgery. The techniques described in the literature include bimanual irrigation aspiration, leaving the plaque for later Yag, bimanual micro phaco, Lambda technique with dry aspiration, Phaco if opacity <4 mm and soft nucleus, pars plana vitrectomy (PPV), pars plana lensectomy (PPL) if opacity >4 mm and soft nucleus, intra-capsular cataract extraction (ICCE) and scleral fixated intraocular lens (IOL) if opacity >4 mm with the hard nucleus, viscodissection, 3 ports PPL, PPV, low parameters phaco, modified epinucleus removal, inverse horse-shoe technique, standard phacoemulsification, chip and flip for soft cataracts, stop and chop for hard cataracts, layer-by-layer phacoemulsification, standard lens aspiration, pars plicata posterior vitrecto-rhexis, manual small-incision cataract surgery, and conventional extracapsular extraction. A posterior capsule rupture rate of 0 to 36% is reported in different series for cataract extraction. To prevent this dreaded complication, surgeons used many modifications. Minimal hydrodissection in posterior polar cataract extraction was described by Fine et al. The authors describe a technique of low flow manual small-incision cataract surgery with minimal hydrodissection and nucleus rotation with no associated posterior capsule rent. This demonstrates that if the fluidics is understood and corrected, then minimal hydrodissection and nucleus rotation is not taboo in posterior polar cataract extraction by manual small-incision cataract surgery.
RESUMEN
Continuous circular capsulorhexis (CCC) was demonstrated independently by Thomas Neuhann, Kimiya Shimizu, and Howard Gimbel in the 1980s and it finds mention in the landmark paper by Gimbel and Neuhann. The authors describe a technique of achieving the rhexis in a stable, viscoelastic-filled anterior chamber using the tunnel floor as the entry. This gets covered by the roof of the tunnel postoperatively and, therefore, does not leak. There is no oar-locking or striae even when cystitome goes beyond the edge of the tunnel. As there is no escape of the viscoelastic substance, there is no change in the pressure or shallowing of the anterior chamber. It is a useful technique for beginners. It is of great help in difficult cases like intumescent cataracts, shallow anterior chambers, hyperopes, nanophthalmos, pseudoexfoliation, small non-dilating pupils, intraoperative floppy iris syndrome (IFIS), and phacomorphic glaucoma.
RESUMEN
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.
RESUMEN
Ever-evolving modern day cataract extraction techniques have been accompanied by the use of smaller quantities and less invasive methods of anesthesia. Topical anesthesia is routinely used for phacoemulsification. However, peribulbar block or some modification of it is used for anesthesia in manual small-incision cataract surgery (MSICS) by most practitioners. The authors describe a technique using a combination of 1.5�milliliters of anesthetic mixture given subconjunctivally and supplemented with commercially available intracameral anesthetic and mydriatic for MSICS. It is possible to get high level of anesthetic effect and ease of surgery with this technique though there is a small learning curve. Several modifications from topical phacoemulsification like two side ports six o抍lock hours apart make this surgery easy to adapt to. No special instrumentation is required. It gives adequate analgesia and anesthesia to complete the surgery. a minimalistic anesthetic approach in MSICS can be used with enhanced safety and by avoiding usual complications of traditional peribulbar and retrobulbar anesthesia.
RESUMEN
Purpose: To study the knowledge, attitudes, and practices of the ophthalmologists in India regarding cataract extraction practices. Methods: A prospective, online, descriptive study was conducted from January 2022 to April 2022 using a self?developed validated questionnaire attached which was administered through a generated link. Results: The mean age of these 153 respondents was 47.02 (SD = 11.53) years with a male preponderance (70.59%). The majority (52.9%) had completed a fellowship after their post?graduation, and 56.20% provided sub?specialty services. Comprehensive ophthalmology (69.93%) and anterior segment (50.32%) practice were the most popular. Although 76.47% of respondents used a mix of techniques, 11.11% surgeons used only phaco?emulsification and 9.8% used only manual small? incision cataract surgery (MSICS) as the lone cataract treatment modality. Roughly 38% felt that outcomes were comparable for phaco?emulsification and MSICS, whereas about 44% opined that the outcomes of phaco?emulsification were better. MSICS outcomes were reported to be better by approximately 15%. The frown incision (53.59%), the straight incision (19.60%), and the straight incision with back cuts (10.45%) were popular. The majority (71.24%) of the respondents were willing to train fellow ophthalmologists and youngsters in MSICS. Standalone practices and family practices (42.48%), private eye institutes (10.45%), medical colleges (12.41%), and government non?teaching hospitals (11.11%) were the major service providers. 4% were working in rural hinterland. Conclusion: The majority of the surgeons use a mix of cataract extraction operative techniques. A large, willing talent pool of manual small?incision cataract surgeons exists. India can be a global hub for MSICS delivery and training
RESUMEN
Purpose: India’s cataract surgery rate has been hovering around a creditable 6000 per million population but the coverage is variable across the geography and demography with sharp urban rural divide. Smaller incisions in manual small incision cataract surgery (MSICS) with phacofracture have been credited with lower astigmatism and faster recovery, which is especially useful for patients traveling for surgeries. Methods: In this retrospective chart analysis based observational study of 66 eyes, we describe the early postoperative results with 2 mm MSICS with phacofracture. Results: The mean spherical equivalent of the autorefractor measured astigmatic error changed marginally to ?0.51 diopters (SD = 0.58) from ?0.44 diopters (SD = 0.42) (t = ?8.410, P = 0.0) translating to mean change in astigmatism of 0.14 DCyl when the axis was ignored. The keratometric difference between steepest and flattest axis of the anterior surface of the central 3 mm zone of the cornea changed from a mean of 0.89 diopters (SD = 0.55) to 1.39 diopters (SD = 1.03). The visual acuity improved to mean logarithm of the minimum angle of resolution (logMAR) score of 0.27 (SD = 0.33) at 1 week and 0.007 (SD = 0.04) which corresponds to 6/6P on Snellen’s acuity at 1 month or more. Conclusion: A 2 mm MSICS with phacofracture can deliver low astigmatism and good visual recovery in cataract surgery. The study underlines the need for considering the refraction at anterior and posterior corneal interfaces when the triplanar incision with separate interfaces is used.
RESUMEN
PURPOSE: To study the knowledge, attitude and practices (KAP) towards computer vision syndrome prevalent in Indian ophthalmologists and to assess whether 'computer use by practitioners' had any bearing on the knowledge and practices in computer vision syndrome (CVS). MATERIALS AND METHODS: A random KAP survey was carried out on 300 Indian ophthalmologists using a 34-point spot-questionnaire in January 2005. RESULTS: All the doctors who responded were aware of CVS. The chief presenting symptoms were eyestrain (97.8%), headache (82.1%), tiredness and burning sensation (79.1%), watering (66.4%) and redness (61.2%). Ophthalmologists using computers reported that focusing from distance to near and vice versa (P =0.006, chi2 test), blurred vision at a distance (P =0.016, chi2 test) and blepharospasm (P =0.026, chi2 test) formed part of the syndrome. The main mode of treatment used was tear substitutes. Half of ophthalmologists (50.7%) were not prescribing any spectacles. They did not have any preference for any special type of glasses (68.7%) or spectral filters. Computer-users were more likely to prescribe sedatives/anxiolytics (P = 0.04, chi2 test), spectacles (P = 0.02, chi2 test) and conscious frequent blinking (P = 0.003, chi2 test) than the non-computer-users. CONCLUSIONS: All respondents were aware of CVS. Confusion regarding treatment guidelines was observed in both groups. Computer-using ophthalmologists were more informed of symptoms and diagnostic signs but were misinformed about treatment modalities.