Manual Vs Instrumental Phaco Dr. Navin Gupta M.S. (Ophthal)

SMALL INCISION CATARACT SURGERY Main objective in modern cataract surgery Better unaided visual acuity Rapid post-op surgical recovery Minimal surgery related complications Achieved by reducing the incision size

TECHNIQUE OF MANUAL SICS Scleral tunnel Corneal valve incision AC entry with keratome Capsulotomy & Hydrodissection Prolapse of nucleus into AC Nucleus delivery with irrigating vectis I/A of cortex IOL implantation

TECHNIQUE OF PHACOEMULSIFICATION Scleral tunnel Corneal valve incision AC entry with keratome Capsulotomy & Hydrodissection (Capsulorrhexis) Divide & conquer or phaco chop technique I/A of cortex IOL implantation

INDICATIONS Universally applicable to all cataracts Ideal in following cases Following RD / Vitrectomy procedures Glaucoma Traumatic Cataracts Patients with Colobomas

CONTRA-INDICATIONS Mainly relative Black cataracts Brown cataracts Deep sockets Small hyperopic eyes Small pupil /PXF Subluxated / dislocated lens

Manual SICS - Learning curve Easier and shorter Rhexis or can-opener capsulotomy Hydrodissection not mandatory Minimal risk of nucleus drop Hand- foot coordination not required Single -handed technique

Phaco- Learning curve Tougher & longer Rhexis is a must Hydrodissection is important Risk of nuclear drop common Hand foot coordination is necessary Mostly two handed technique

MANUAL SICS - INSTRUMENTATION Non-machine dependent technique Needs only a simple irrigating vectis or a spatula

PHACOEMULSIFICATION- INSTRUMENTATION Money / Machine dependent technique Technical knowledge of machine parameters must Parameters are different for different machines Training of OT paramedical staff

Manual SICS - Cost effectiveness No machine cost No cost of reusables Requires less fluids and viscoelastics High volume cheaper than ECCE

Phacoemulsification- Cost effectiveness Machine cost Cost of consumables eg. Phaco tip, sleeve tubing, probe Requires more fluid and viscoelastics Problems of machine failure

Average time of surgery Manual SICS – 4 to 8 mts Not influenced by nucleus hardness PE technique - 12 to 15 mts Dependent on type of cataract

Turnover of cases / hour Phacoemulsification - 4 to 5 cases Manual SICS - 14 to 15 cases Ideal for large volume conversion

SURGICALLY INDUCED ASTIGMATISM SIA between MSICS and Phaco with rigid IOL - not statistically significant

Conclusion Manual SICS offers all the advantages of Phacoemulsification Less induced astigmatism Faster stabilisation of final refraction Less tendency towards ATR shift Comfortable postoperative period

CONCLUSION Manual SICS is superior to phacoemulsification Easier to learn Cost effective Not machine dependent Short procedure Postoperative results comparable to PE Ideal alternative to ECCE with IOL for large volume surgery

Manual Vs Instrumental Phaco  $ $