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

2. 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

3. 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

4. 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

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

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

7. 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

8. 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

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

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

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

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

13. 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

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

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

16. 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

17. 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

18. Manual Vs Instrumental Phaco
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