Manual Small Incision Cataract Surgery For The Management Of Very Dense Brown Or Black Cataracts At Moorfields Eye Hospital

Phacoemulsification is the commonest technique for cataract surgery in the UK. Very dense brown (brunescent) or black (cataracta nigra) cataracts increase the risk of complication with phacoemulsification. Manual Small Incision Cataract Surgery (MSICS) is an alternative form of extracapsular cataract extraction (ECCE). The main advantage of MSICS over traditional ECCE is the smaller incision and self-sealing sutureless wound. Whilst MSICS is the commonest surgical procedure performed for cataracts in many parts of the world, it is not currently taught as part of the UK training curriculum and few ophthalmologists are trained to plan or undertake MSICS. We evaluate the clinical and safety outcomes of MSICS at a UK tertiary centre hospital.

A large tertiary centre National Health Services (NHS) teaching eye hospital in the UK.

Retrospective audit of the outcomes of MSICS in the removal of dense brown and black cataracts by one consultant ophthalmologist. The study period was 01/01/21 – 31/01/24. Data extracted from the electronic medical records included patient demographics, risk factors, pre and post-operative best corrected visual acuity (BCVA) and autorefraction and intraoperation and post-operative complications. Posterior capsule rupture (PCR) risk for each eye was calculated based on the Cataract National Dataset electronic multicentre audit of 55,567 operations. Primary and secondary outcomes were the percentage of eyes achieving BCVA ≥6/12 and the percentage of eyes achieving a spherical equivalent within 1D of the target refraction respectively.

17 eyes from 15 patients underwent MSICS during our study period. The age range was 43-96 years (Mean 70.9). Wound closure required sutures in 11.8% (n=2) eyes. 76.5% (n=13) eyes achieved post-operative BCVA ≥6/12 including all eyes with good visual potential. 84.6% (n=11) eyes with recorded post-operative refraction achieved spherical equivalent within 1D of the target refraction. The average PCR risk calculation for the included eyes was 8.8% and the intra-operative complication rate was 5.9% (n=1), an anterior capsule wrap around tear without vitreous loss. Post-operatively, 1 eye underwent further surgery due to hypotony secondary to a leaking sclero-corneal wound.

Our data shows a comparable safety profile of MSICS when compared to phacoemulsification in the management of very dense brown and black cataracts. As MSICS is a safe and sutureless alternative method for surgical removal of dense brown and black cataracts, we need to increase awareness and exposure to MSICS within the UK as a suitable alternative technique for such cases. Including MSICS training in the UK curriculum will enable trainees to consider this as an alternative technique in the surgical planning of patients with very dense brown and black cataracts.