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Small Incision Cataract Surgery (SICS) and IOL Implantation

Dr. P.Mishra

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Discussion: The post operative visual acuity,best corrected was 6/12-6/18 or better in 82% of cases after 4 weeks. In 6 cases minimal corneal oedema subsided within 2 weeks of surgery. However in 4 cases there was irreversible corneal oedema because of endothelial trauma. This complication will be much lower as one’s learning curve is crossed. The severe corneal oedema was due to endothelial decompensation which was mostly seen in the later half of 50 cases perticularly in the camp cases,where large number of cases were operated in a single day. The results of first 50 cases were better and more encouraging may be because of extra care taken during switch over to a new procedure. In 2 cases there were inferior iridodialysis and total hyphaema which cleared slowly and visual acuity improved to 6/24 and 6/36 after 2 months of surgery. The iridodialysis in the lower part was because of iris trapped in between microvectis and nucleus during delivery of nucleus. This can be avoided by injecting adequate amount of viscoelastic into the anterior chamber andalso if little care is taken during nucleus management. In one case there was zonulodialysis IOL was dislocating into the vitreous which was explanted immediately intraoperatively. In other four cases there was PC rent and vitreous loss which was managed by vitrectomy, IOL implanted in the sulcus in three cases and in one case it was implanted in the anterior chamber. In 6 cases of complicated cataracts there was thick layer of posterior cortex, it was difficult to aspirate ,however in two cases reoperation, I/A was done easily in the second post operative period following which visual acuity improved to 6/12 and 6/18 respectively.

Although there is lack of extensive study regarding this technique(SICS),in early nineties Kansas described the phacofracture and Luther Fry the phacosandwich technique. Richard Gianetti in 1996 reaffirmed, the nucleus capture is an inexpensive, phacoless, repeatable and relatively easy method of performing tunnel incision cataract surgery. He also stressed that no side port incision is required, surgeons can obtain the benefits of small self sealing incision without the added cost of phaco.4 In all the 100 cases of this study, no side port entry was done and nucleus was delivered with the help of microvectis,small lens loop.

Conclusion: Small incision cataract surgery has contributed considerably to acclerated wound healing and minimisation of hospitalisation. The technique used here is neither phaco fracture non-phaco sandwich but nucleus is delivered by means of a microvectis with tunnel incision of size 6.5-7.5 mm for soft cataracts, and around 10 mm for rockhard cataracts. This tunnel cataract surgery is inexpensive, phacoless, relatively easy, repeatable and can be performed for any type of cataract from childhood to rockhard nuclear cataract. No side port entry is required. The wound is more secure with reduced intraoperative complications and virtually no chance for expulsive haemorrage.5 Childhood cataract is much easier as there is no nucleus and in no time chamber collapses during surgery. One can achive faster and satisfactory visual rehabilitation (image 4) without added cost of phaco and its long and risky learning curve. According to S.N. Fyodorov, Life does not stand still for a single minute, what is considered brand new today becomes outdated tomorrow. So is it not high time now to say goodbye to phaco?

References

  1. Nielson P.J., Allerod C.W Evaluation of local anaesthesia technique for SICS. Journal cataract Refract. Surg.1998: 1136-44.
  2. Kapoor Sashi Incisions. Emmetropia, Journal Intraocular Implant and Refract. Society.1999; 2:17-25.
  3. Mody Kirit,Singh Gagan J Small incision Non phaco cataract surgery. Emmetropia, Journal Intraocular Implant and Refract. Society.1999; 2:9-11.
  4. Giannetti Richard Phacoless nucleus capture through a no stich tunnel incision appears to control astigmatism. Ocular Surgery News International.1996; 7: 14-15.
  5. Kumar Ravindra Small incision cataract surgery without phaco-My experience. Emmetropia, Journal Intraocular Implant and Refract. Society.1999; 2:53-55.

Professor of Ophthalmology, RMMCH, Annamalai University-608002, Tamilnadu

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