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A safe and effective way of converting from phaco to a manual technique in the middle of surgery

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Session Details

Session Title: Orbis Free Paper Session: Treatment and Prevention of Blindness in the Developing World

Session Date/Time: Monday 09/10/2017 | 12:30-13:00

Paper Time: 12:36

Venue: Meeting Center Room III

First Author: : P.Kuruvilla INDIA

Co Author(s): :    A. Kuruvilla   S. Kuruvilla                 

Abstract Details


Some times a phaco surgeon is forced to convert to an alternative technique in the middle of surgery because of a mechanical failure of the machine or a surgical complication (runaway rhexis, Argentine flag sign, posterior capsular rent, torn IOL haptic, etc). In the developing world, the surgeon also has the extra pressure on him/her to complete a big list of surgeries that day. The purpose is to present a new method to complete surgery without the aid of phaco machine, without inducing additional astigmatism (provided it is a temporal incision) and without suturing.


Aradhana Eye Hospital, Trivandrum, India, a secondary eye care centre. A 2.8 mm keratome incision is made temporally to do phacoemulsification. Rhexis done. Trenching starts. The machine fails. The nurse says it may take a long time to get it ready. The surgeon wants an alternative technique to complete surgery.


It involves making 30 degrees back cuts on the conjunctivo sclera (half thickness of sclera) from the ends of the limbal phaco incision. A sclero corneal tunnel is made continuous with the original tunnel made for phacoemulsification on both sides of the original cut. If in case the phaco tunnel is in a deeper plane, the new tunnel can be made anterior to the original one. The nucleus is rotated to anterior chamber and taken out by a sandwich technique, cortex washed and IOL inserted.


The triangular scleral parts of the tunnel on either sides heal well because of vascularity. There is no need for sutures. The healed scleral tunnels which act like “pillars” make it difficult for the internal corneal wound to slide . It thus prevents occurrence of any further surgically induced astigmatism . Disadvantages: 1) A temporary cosmetic blemish (temporal incision) because of redness. 2) If it is a superior incision, the described side extensions do induce some additional astigmatism 3) The surgeon must be adept with Manual Small Incision Cataract surgery.


Sometimes even an experienced phaco surgeon may have to convert to a manual technique in the middle of phaco surgery, ( machine break down which may take a long time to fix in developing countries, unexpected development of surgical complications). The traditional methods of converting to ECCE or Manual SICS involve suturing and additional surgically induced astigmatism. Here is a technique without such issues. However, for optimal results with this technique, it should be a temporal limbal incision and the surgeon should be adept with Manual SICS .

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