Nucleus management with irrigating vectis

Aravind Eye Hospital and Postgraduate Institute of Ophthalmology, 1, Anna Nagar, Madurai - 625 020, India.
Indian Journal of Ophthalmology (Impact Factor: 0.93). 01/2009; 57(1):19-21. DOI: 10.4103/0301-4738.43045
Source: PubMed

ABSTRACT The main objective in modern cataract surgery is to achieve a better unaided visual acuity with rapid post-surgical recovery and minimal surgery-related complications. Early visual rehabilitation and better unaided vision can be achieved only by reducing the incision size. In manual small incision cataract surgery (MSICS), incision is between 5.5 to 7 mm. Once the nucleus is prolapsed into the anterior chamber, it can be extracted through the tunnel. Nucleus extraction with an irrigating vectis is a very simple technique, which combines mechanical and hydrostatic forces to express out the nucleus. This technique is time-tested with good results and more than 95% of nuclei in MSICS are extracted in this way offering all the merits of phacoemulsification with the added benefits of having wider applicability, better safety, shorter learning curve and lower cost.

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    • "This technique has gone into disrepute with the modifications by Extra-Capsular Cataract Extraction (ECCE) that ensures retention of posterior capsule, intact anterior vitreous face and relatively less distorted ocular anatomy and optics. Modified Blumenthal [11] , phacofracture [12] , viscoexpression [13] , phacosandwich [14] , irrigating vectis [15] and fish hook [16] techniques are some of the modalities of delivering hydrodissected and prolapsed nuclei. MSICS is the surgery of choice in most developing countries. "
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    ABSTRACT: Purpose: To appraise the learning pattern in Manual Small Incision Cataract Surgery (MSICS) of a trainee ophthalmologist. Setting: Sankara Eye Hospital, Pammal, Chennai, India. Design: Retrospective study. Methods: Case files of patients who underwent MSICS during the training were reviewed. Surgical complications, nucleus density, extent of supervisors' intervention in surgeries and visual acuity were either tabulated or graphically presented. Two-way ANOVA and multiple regressions were used to compare dependent variables. Results: There were 123 eyes of 123 patients {males 49 (39.8%), females 74 (60.2%)}. The mean age was 63.19 + 6.6 years with a range of 40-80 years. The worst post-operative visual acuity (VA) was in the first month of training. With an overall complication rate of 30.9%, posterior capsular rent (PCR) was most prevalent in eyes operated in the first month of training (3 of 18 eyes, 16.7%). Supervisors' intervention in surgeries was highest in the first month of training and declined as training progressed. Fischer's Exact test for intraoperative complications and extents of supervision showed a statistically significant (P = 0.012). Multiple logistic regression analysis showed that density of nucleus was statistically significant (P = 0.02). Conclusions: Three months appear sufficient for learning the surgical rudiments of MSICS for a trainee with a modest competence in Extra-capsular Cataract Extraction (ECCE), especially if surgeries are performed on a continuous basis during the period.
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