Manual Small Incision Cataract Surgery (MSICS) Ashok Garg, Luther L Fry, Francisco J Gutiérrez-Carmona, Amulya Sahu
INDEX
A
3 mm manual SICS 43
ACM in phacoemulsification 208
mini-incisional surgery 209
Anterior capsulotomy 11
B
Blumenthal's technique in MSICS 153
advantages 173
anterior chamber main-tainer (ACM) 154
capsulotomy 158
closing up 172
cortical clean up 168
hydroprocedures and
nucleus prolapse 163
IOL insertion 170
principle 154
scleral incision 159
side ports and ACM port 155
tunnel and internal opening 159
C
Capsulorhexis 45
Caveats 28
Closed chamber manual phacofragmentation 137
Cortex aspiration 21
D
Delivering the nucleus out of the bag 49
Delivery of nucleus into the anterior chambers 230
Delivery of the nucleus out of the AC 50
H
Hydrodissection 13, 48
Implantation of intraocular lens 102
advantages 108
disadvantages 110
I
Intraoperative complications and their avoidance in small incision cataract
surgery 278
capsulotomy 280
dialysis or rupture of the
posterior capsule 281
iris trauma 283
nuclear luxation 280
wound construction 278
M
Manual multiphacofragmen-tation (MPF) 31
surgical technique 34
anterior capsulotomy 34
extraction of the cortex and remains
of nucleus 39
hydrodissection and luxation of the
nucleus 36
incision 35
IOL implantation and wound closure 40
manipulation of nuclear fragments 39
nuclear fragmentation 37
Manual phacocracking 55
complications 60
visual outcomes 60
principles 56
surgical techniques 56
Manual small incision cataract surgery using
irrigating vectis 177
surgical procedure 178
capsulotomy 179
irrigation-aspiration of the cortext 185
management of hard cataracts 184
nucleus removal 180
peritomy 178
scleral tunnel and side port incision 178
Modified Blumenthal technique 202
assisted delivery 205
insertion of ACM 202
principle of the technique 204
MSICS in difficult situations 213
cataracts with existing filtration blebs 225
cataracts with pseudoexfo-liation 224
hard black cataract 222
small pupil 214
managing intraopera-tive miosis 215
managing non-dilating pupil 216
technique of stretching small pupil 217
subluxated cataracts 223
white cataract 219
N
Nucleus delivery 14
Nucleus management by viscoexpression technique
in manual SICS 121
P
Phacofracture and phaco-section 207
Phacofracture techniques in SICS 113
surgical technique 114
anesthesia 114
capsulorhexis 115
complications 119
hydroprocedure 116
incision 115
nuclear luxation 116
nucleus delivery 117
Phacosection technique in MSICS 61
cortical aspiration 100
entry into the eye 70
add on anesthesia 71
peritomy 73
preparation 70
separation of eyelids 71
superior rectus 72
fluidics and open and closed chamber concepts 80
anterior capsulotomy 82
instrumentation 65
6 mm marker 69
cannulas 67
cystitomes 66
irrigating fluid 69
methylcellulose (HPMC) 69
scleral tunnel blades 65
sinskey hook 68
wire vectis 69
nucleus management 88
hydroprocedures 88
patient selection, preparation and
anesthesia 62
anesthesia and akinesia 63
patient preparation 63
tunnel incision 74
Postoperative complications and their avoidance in MSICS 284
corneal edema 284
high intraocular pressure 284
postoperative endophthalmitis 285
shallow anterior chamber 284
R
Removal of nucleus out of the wound 232
various techniques 232
Blumenthal technique 233
chop bisector/chop trisector and chopsticks technique 253
double wire snare splitter technique 266
fish hook technique 257
hybrid technique 261
jaws slider pincer technique 263
manual multiple phacofragmentation 248
manual phacocracking 270
manual phacofractrue Cardona's technique 244
nucleus removal using irrigating wire vectis 234
phaco sandwich technique 246
phacofracture 238
phaco-punch technique 260
prechop manual phacofragmentation 251
quarters extraction technique for manual phacofrag-mentation 253
use of claw vectis 254
using of plain wire vectis 255
viscoexpression 237
S
Small pupils 7
Sutureless cataract surgery with nucleus extraction: fishhook technique 187
hook 188
learning curve 199
outcome 197
special highlights 199
technique 190
capsular opening 191
completing the surgery 197
hydrodissection and nucleus mobilization 192
nucleus hook extraction 193
T
Tenon's capsule 123
U
Update on various nucleus delivery techniques in manual small incision cataract surgery 229
V
Versatility of anterior chamber maintainer (ACM) in SICS 201
Viscoexpression of epinucleus 132
Viscoexpression of the nucleus 131
×
Chapter Notes

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1Jaypee Gold Standard Mini Atlas Series®
Manual Small Incision Cataract Surgery (MSICS)
2
Jaypee Gold Standard Mini Atlas Series®
Manual Small Incision Cataract Surgery (MSICS)
Editors Ashok Garg MS, Ph.D., FIAO (Bel) FRSM, ADM, FAIMS, FICA International & National Gold Medalist, Medical Director Garg Eye Institute & Research Centre 235-Model Town, Dabra Chowk, Hisar-125005 (India) Francisco J Gutérrez-Carmona MD, Ph.D Associate Professor Ophthalmologic Research Institute, Ramon Castroviejo, Zarracin 25-Urb La Berzosa, 28240, Hoyo de Manzanares, Madrid (Spain) Luther L Fry MD Director Fry Eye Associates, PA/Ophthalmology, 340, East Walnut, Kansas 67846-2562, Garden City (USA) Amulya Sahu MS Director Sahu Eye Hospital, A-1, Wimla Apts., Marve Road, Malad (West), Mumbai-110064 (India) MS Ravindra MS Director Karthik Netralaya, 89, 7th Cross, NR Colony Bangalore-560050 (India) Foreword Carlos Infantes
3
Published by
Jitendar P Vij
Jaypee Brothers Medical Publishers (P) Ltd
B-3 EMCA House, 23/23B Ansari Road, Daryaganj, New Delhi – 110 002, India
Phones: +91-11-23272143, +91-11-23272703, +91-11-23282021, +91-11-23245672
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Jaypee Gold Standard Mini Atlas Series® MSICS
© 2008, Jaypee Brothers Medical Publishers
All rights reserved. No part of this publication should be reproduced, stored in a retrieval system, or transmitted in any form or by any means: electronic, mechanical, photocopying, recording, or otherwise, without the prior written permission of the editors and the publisher.
First Edition: 2008
9788184482768
Typeset at JPBMP typesetting unit
Printed at Ajanta Offset
4Dedicated to
Ashok Garg
My wife, Ardis and my sons, Eric and David whose sacrifices have made my career in ophthalmology possible.
Luther L Fry5
My wife, Carmen and my daughters Marta and Laura for their love and support. All my teachers and particularly Prof. Ramon Castroviejo who taught me the elegance and excellence in ocular surgery.
Dr Amar Agarwal for his friendship.
Francisco J Gutierrez-Carmona
To my parents for their love, to my wife for her faith, to my sons, Dr Chinmaya Sahu and Dr Aditya Sahu for their companionship, to almighty for making life meaningfull.
Amulya Sahu
6CONTRIBUTORS 8FOREWORD
Small incision manual cataract surgery has also improved significantly with the passage of time. As a matter of fact similar results as with phacoemulsi-fication can be obtained. Using this approach in difficult cases was still possible without having to enlarge the incision to 10-12 mm. Independency from technology becomes important in many situations. Also when speaking to surgeons who do or have practised SIMCS, there is a common agreement that transition to phaco-emulsification was easy. The intraocular manipulation, respecting the eye structures required by SIMCS makes the difference as opposed to plain transition from planned ECCE to phacoemulsification.
I greatly appreciate that such an excellent and experienced communicator as Dr. Ashok Garg, has combined his effort together with the co-editors Dr. Luther L. Fry, Dr. Francisco J. Gutiérrez-Carmona, Dr. Amulya Sahu and Dr. MS Ravindra to write Mini Atlas Book, with the important contribution of a selected group of experts in this field.
The book is mainly dedicated to describe several manual techniques including nuclear manipulation or 9fragmentation, fragment extraction, strategies in the use of several viscoelastic devices, the use of an anterior chamber maintainer, etc. A whole chapter on complications and their avoidance is also included. In other words, the reader will find many ideas to either learn or enrich from his manual small incision cataract surgery mini atlas.
I would like to give my warmest thanks to Dr. Ashok Garg for honouring me with the task of writing the foreword to his book. I am convinced that it will help many surgeons to improve their surgical skills for the benefit of their patients.
Carlos Infantes
Medical Director
Clínica Oftalmológica Dr. Infantes
03730 Jávea (Alicante) Spain
Tel. 96 5791229
Fax: 96 6460424
Mob.699 967011
10PREFACE
Manual Small Incision Cataract Surgery (MSICS) has improved significantly with the passage of time. Similar visual results can be obtained as with phaco with much lesser costs. Being proficient in MSICS not only makes the ophthalmologist independent of machine technology but also it has many other advantages as it is very useful in difficult situations like hard cataracts. Proficiency in MSICS makes the transition to phacoemulsification much easy.
This Mini Atlas of MSICS contains 15 chapters covering various techniques of MSICS beautifully by International Masters of this field. All MSICS techniques are described with more figures step by step for better understanding.
We are thankful to Shri Jitendar P Vij, Chairman and Managing Director, Mr Tarun Duneja (General Manager, Publishing) and all staff members of M/s Jaypee Brothers Medical Publishers (P) Ltd. for active interest and support provided in the publication.
This Mini Atlas on MSICS shall be invaluable companion to ophthalmologists as ready reckoner in operation theatre and clinical OPD for quick review.
Editors