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: 0.9). 03/2009; 57(1):19-21. DOI: 10.4103/0301-4738.43045
Source: PubMed


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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    • "The literature suggests that there are a variety of methods for nucleus extraction in sutureless MSICS. The most widely adopted technique is the irrigating vectis technique (Srinivasan, 2009) in which an irrigating vectis is inserted under the nucleus, with or without irrigating water, and then removed out of the eye. In addition, there are other techniques for nucleus extraction, such as the phacosandwich technique (Bayramlar et al, 1999), phacofracture technique (Kansas and Sax, 1988), When the end of the Sinskey hook is lifted, the main wound is opened in a fish-mouth shape. "
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    ABSTRACT: Introduction: In manual, tunnel-incision cataract surgery, nucleus extraction has remained a crucial issue and a challenge. It is also the period when serious complications easily occur, especially for beginners and when the nucleus is large and dense. Objectives: To report a modified vectis technique for nucleus extraction in sutureless, manual, small-incision cataract surgery (MSICS) to improve the safety and ease of performance. Materials and methods: A novel nucleus extraction technique using a vectis in MSICS is presented. After capsulorhexis and hydrodissection, the nucleus is moved into the anterior chamber and extracted by pulling with a Sinskey hook and pressuring on the scleral bed near the posterior wound margin with an irrigating vectis. Main outcome measures: The operating time for the whole surgery and nucleus extraction, best corrected visual acuity postoperatively and complications during and after operation were recorded. Results: In a series of 1,180 eyes, the operating time for the whole surgery and nucleus extraction were 8±3.4 minutes and 5.1±4.6 seconds respectively. Among all the eyes, 88.98 % achieved a best-corrected visual acuity of 5/10 or better two months postoperatively. The complications were posterior capsule rupture (4 eyes, 0.34 %) and transient corneal edema (12 eyes, 1.02 %). Neither vitreous loss nor dislocation of the nucleus into the vitreous was noted in the whole series of the surgery. Conclusions: We found that the "scleral bed" vectis technique for nucleus extraction improved the ease of performance, safety of MSICS, and did not require expensive instrumentation. © NEPjOPH.
    Nepalese journal of ophthalmology : a biannual peer-reviewed academic journal of the Nepal Ophthalmic Society : NEPJOPH 07/2014; 6(12):140-144. DOI:10.3126/nepjoph.v6i2.11708
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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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    ABSTRACT: Cataract surgery at present is divisible into two general techniques: manual extracapsular cataract extraction and phacoemulsification--with ECCE further separated into the traditional form and small-incision cataract surgery. This review will discuss updates in surgical techniques, outcome comparisons, cost analysis, and the continued role of extracapsular cataract extraction in Western countries. Surgical techniques for manual extracapsular cataract extraction have undergone much refinement, with numerous descriptions of techniques in a recent literature. Studies that have emerged in the last several years allow us to compare surgical results between different techniques and suggest that there is little difference in final outcome when each surgery is done well. Overall cost-effectiveness and suitability of each technique vary based on location and facilities. Manual extracapsular cataract extraction (especially small-incision versions) occupies an important place in modern cataract surgery, and, while not a replacement for phacoemulsification in Western countries, should be part of a cataract surgeon's overall skill set.
    Current opinion in ophthalmology 11/2010; 22(1):37-42. DOI:10.1097/ICU.0b013e3283414fb3 · 2.50 Impact Factor
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