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Small Incision Cataract Surgery (Non Phaco SICS)

Dr. P. Mishra

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Abstract:

Purpose: To evaluate the technique and visual outcome of a prospective series of Non phaco Scleral tunnel sutureless Cataract surgery and I.O.L. implantation.

Methods: Nine hundred seventy cases of various types of cataract, which include 790 cases of senile cataract, 110 cases of complicated cataract, 50 cases of childhood cataract and 20 cases of traumatic cataract were taken for this study. Following sclerocorneal tunnel incision, capsulorhexis, hydro dissection, nucleus was delivered with the help of lens loop (microvectis). I/A was done with simcoe canula and lens implanted either in the bag or in the sulcus. In peadiatric patients, anterior chamber is reformed with air at the end of the surgery. Surgical complications, visual acuity at discharge, 2 weeks, 4 weeks and 6 months follow up are reported.

Results: Visual acuity corrected after 4 weeks was 6/18 or better in 95.97% of eyes in adult group, 54% in childhood cataract group. Complications like mild iritis is seen 80(8.24%) eyes, severe endothelial damage in 6(0.61%) eyes, intra operative complications like inferior iridodialysis noticed in 2(0.20%) eyes, damage to scleral spur and cyclodialysis in 3 eyes, hyphema in 4(0.41%) eyes, pc rent in 12(1.23%) eyes out of which vitreous loss in 8 eyes, IOL decentred in 3 eyes and IOL dislocated into vitreous in two eyes, which were removed intra-operatively. Posterior capsular opacification noticed in 82(8.45%) eyes, poor visual acuity noticed in 9 (1.03%) eyes in adult cataract group. One eye (0.10%) developed severe endophthalmitis.

Conclusion: SICS (Non-phaco) is our routine technique for all types of cataract, It involves nucleus expression by a microvectis of 4-5 mm size. The scleral tunnel incision varies from 6- 7.00 mm depending on types of cataract. Side port is necessary in difficult cases for rhexis and aspiration of sub incisional cortex. All the blades used are indigenous ones. Rapid visual recovery, and over all visual acuity corrected after 4 weeks is satisfactory. This suture less technique also extended to peadiatric cataracts(> 2 yrs of age), where A/C was reformed with air bubble at the end of the surgery. Considering it’s low cost and rapid visual recovery, we recommend this simple technique for all types of cataract in the developing countries.

Key words: SICS, Scleral tunnel, Non phaco, Manual phaco, IOL implantation.

Introduction:

Cataract surgery has witnessed a phenomenal progress over the years with addition of newer surgical technique and instrumentation. The methods of ICCE and ECCE, which we learned during our postgraduate training is perhaps no more in practice. Non phaco sutureless cataract surgery is the need of the hour in developing countries because, it is cost effective. Neither our patients nor the surgeons can afford phaco-emulsification (PE) procedure. Overall the technique of phacoemulsification (PE) is confined to a limited no.of surgeons in the developing countries because of the high cost of the equipment and it’s consumables. That is the reason why there is renewed interest in Non phacoemulsification small incision cataract surgery (Non Phaco SICS) in the third world countries. Several methods have been described for nucleus removal in SICS, in this procedure entire nucleus is removed through a sclerocorneal tunnel by a microvectis. We have been performing this technique in all types of cataract in our institute, Rajah Muthiah Medical College Hospital since last one decade, so far more than 10,000 small incision cataract surgeries have been performed including paediatric cases. This particular technique (microvectis) in SICS is evaluated and reported in this prospective study.

Materials and Methods:

Nine hundred and seventy consecutive cases of various cataracts, attending to ophthalmology OPC of R.M.Medical College Hospital, Annamalai University are the subjects of this study and all the cases operated by single surgeon (PM) were taken up for this study. This includes 790 cases of senile cataract, 50 cases of child- hood cataract and 110 cases of complicated cataract and 20 cases of traumatic cataract.Thorough preoperative evaluation of anterior segment of the eyes was done by biomicroscope, posterior segment by B scan ultrasonogram and indirect ophthalmoscope. The cases with coexisting posterior segment disorders were excluded from the study. The keratometry and I.O.L. power were calculated using Teknar Image 2000 A and B scan. The surgeries were performed under peribulbar anaesthesia except for childhood cataract, which were undertaken with general anaesthesia. Peribular anaesthesia was achieved by giving 2 injections, mixture of 5cc of 2% xylocaine with 5cc of 0.5% bupivacaine by two points technique without adding hylase. Facial N. block was avoided in all the cases. Ocular hypotony was achieved by ocular compression with pinky ball.


Fellow Retina Foundation, Professor of Ophthalmology, RMMCH, Annamalai University-608002, Tamilnadu

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