A New Hybrid Technique Technique: Phacoemulsification With Sics. Need Of The Third World Countries.

To Study the Efficacy of a Newly Developed Hybrid Technique In a Third world Setting.  At the beginning of the Year 2023,  the leading Tertiary Eye care Hospital in Kenya was forced to switch to SICS due to the stoppage of Government funds. Most patients are from NHIF [ National Hospital Insurance Fund], and all underwent routine phaco till 2022. So, as a Necessity, this technique was born...which is a hybrid of Phaco and SICS with a reduced incision size of 6.0 mm for any grade of Cataract. 

PHACO-SICS is both sics and phaco. All procedures were done at LIONS SIGHTFIRST EYE HOSPITAL in Nairobi, Kenya. Insurance patients undergo the procedure of Phaco. Many surgeries are done with basic mono-focal foldable iols from different companies, including leading Multinational companies. Even edof and multifocal/trifocal lenses are implanted routinely. Most patients come thru NHIF, a government-funded NATIONAL HEALTH INSURANCE FUND. Stoppage of funding led development of this technique. 

PHACO-SICS.  A 6.0 mm incision is given in the sclera 1.0 mm away from the corneal limbus. The outer incision is 6.0 mm, while the inner corneal incision is 2.65 mm. CCC is done. Phaco is done in sculpt mode only. Initially, cataract was divided into two equal half. Then several combinations of different cataract sizes were attempted. i.e., to bisect the cataract in two unequal sizes.  e.g., 30-70 (one half 30 percent and the other 70 percent ). It was found 40-60 ratio was best. ( 40 percent one-half and 60 percent one-half) . The reason was in hard cataracts, it became difficult to prolapse cataracts when they were divided in a 50-50 ratio. The pieces got stuck to each other.  I/A and rigid pmma implanted. Conjunctiva opposed and sutured.

A total of 23 patients were selected for this Procedure. Initially, the time was close to 30 minutes as both phaco and sics were attempted on the same eye.  Four patients had complications.  [ all zonular dialysis and vitreous prolapse ]. This was whenever the cataract was divided into equal parts. It was difficult to prolapse the cataract piece in hard cataracts from within the ccc margin with two Lester manipulators. Out of these, one eye got in the bag implantation, and the rest got implantation in the sulcus. All four underwent vitrectomy.  Two patients had large internal wounds, and it was difficult to sculpt with the leaky wounds but were completed without complications.  Five patients required a single stitch. Rest are very good. 

The Technique is safe and effective. Surgeons Proficient with Both Procedures of Phacoemulsification and Small Incision Cataract Surgery can easily and quickly adapt to this Hybrid technique. The learning curve is short for Experienced Surgeons. Tertiary High Volume Eyecare Centres dependent on Government Funds can easily benefit from this technique whenever Funding is stopped for foldable iols and surgeons are forced to implant rigid PMMA material lenses.  An incision size of 6.0mm is enough for the Hardest of the Cataracts. The Results are better than SICS. If Sics with a 10mm incision is not equal to PHACO then this  HYBRID TECHNIQUE is. And with clear corneas in the hardest cataracts on post-op day ONE.