Small Incision Cataract Surgery
The place and relevance of manual small incision cataract surgery
Modern cataract surgery aims to achieve a better unaided visual acuity with rapid post surgical recovery and minimal surgery related complications. Early visual rehabilitation, better unaided visual acuity and surgical safety can be achieved in a great measure by reducing the incision size. Incision size depends on the mode of nucleus delivery and the type of intraocular lens used. It is about 10-12 mm in standard extracapsular surgery, about 5.5 mm to 7.0 mm in manual small incision surgery and 3 mm to 5.5 mm in instrumental phacoemulsification, depending upon the technique and implant.
The advantages associated with the smaller incision have made phacoemulsification the ideal technique for cataract surgery and the preferred one where the resources are available. However, this technique cannot be employed as the standard procedure in developing countries due to certain reasons. Manual small incision cataract surgery offers similar advantages with the merits of wider applicability, better safety, a shorter learning curve and lower cost.
This technique is an evolution of Extracapsular cataract extraction where the entire lens is expressed out of the eye through a self-sealing scleral tunnel wound. An appropriately constructed scleral tunnel is watertight and does not require suturing. The “small” in the title refers to the wound being relatively smaller than an Extracapsular cataract extraction, although it is still markedly larger than a phaco wound. Head to head trials of Small Incision Cataract Surgery vs phaco in dense cataracts have found no different in outcomes, but shorter operating time and significantly lower costs with Small Incision Cataract Surgery.