Manual Vs Instrumental Phaco Dr. Navin Gupta M.S. (Ophthal)

A R A V I N D E Y E H O S P I T A L SA R A V I N D E Y E H O S P I T A L S& Postgraduate Institute of Ophthalmology

Manual Vs Instrumental Manual Vs Instrumental PhacoPhaco

Dr. Navin Gupta M.S. (Ophthal)Dr. Navin Gupta M.S. (Ophthal)

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SMALL INCISION CATARACT SMALL INCISION CATARACT SURGERYSURGERY

Main objective in modern cataract surgeryMain objective in modern cataract surgery• Better unaided visual acuityBetter unaided visual acuity• Rapid post-op surgical recoveryRapid post-op surgical recovery• Minimal surgery related complicationsMinimal surgery related complications

Achieved by reducing the incision size Achieved by reducing the incision size

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TECHNIQUE OF MANUAL SICSTECHNIQUE OF MANUAL SICS

Scleral tunnelScleral tunnel Corneal valve incisionCorneal valve incision AC entry with keratomeAC entry with keratome Capsulotomy & HydrodissectionCapsulotomy & Hydrodissection Prolapse of nucleus into ACProlapse of nucleus into AC Nucleus delivery with irrigating vectis Nucleus delivery with irrigating vectis I/A of cortexI/A of cortex IOL implantationIOL implantation

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TECHNIQUE OF TECHNIQUE OF PHACOEMULSIFICATIONPHACOEMULSIFICATION Scleral tunnelScleral tunnel Corneal valve incisionCorneal valve incision AC entry with keratomeAC entry with keratome Capsulotomy & Hydrodissection Capsulotomy & Hydrodissection

(Capsulorrhexis)(Capsulorrhexis) Divide & conquer or phaco chop Divide & conquer or phaco chop

technique technique I/A of cortex I/A of cortex IOL implantation IOL implantation

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INDICATIONSINDICATIONS Universally applicable to all cataractsUniversally applicable to all cataracts Ideal in following casesIdeal in following cases

Following RD / Vitrectomy Following RD / Vitrectomy proceduresprocedures

Glaucoma Glaucoma Traumatic CataractsTraumatic Cataracts Patients with ColobomasPatients with Colobomas

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CONTRA-INDICATIONSCONTRA-INDICATIONSMainly relativeMainly relative Black cataractsBlack cataracts Brown cataractsBrown cataracts Deep socketsDeep sockets Small hyperopic eyesSmall hyperopic eyes Small pupil /PXFSmall pupil /PXF Subluxated / dislocated lensSubluxated / dislocated lens

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Manual SICS - Learning curveManual SICS - Learning curve

Easier and shorter Easier and shorter Rhexis or can-opener capsulotomyRhexis or can-opener capsulotomy Hydrodissection not mandatoryHydrodissection not mandatory Minimal risk of nucleus dropMinimal risk of nucleus drop Hand- foot coordination not requiredHand- foot coordination not required Single -handed techniqueSingle -handed technique

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Phaco- Learning curvePhaco- Learning curve

Tougher & longerTougher & longer Rhexis is a mustRhexis is a must Hydrodissection is importantHydrodissection is important Risk of nuclear drop commonRisk of nuclear drop common Hand foot coordination is necessary Hand foot coordination is necessary Mostly two handed techniqueMostly two handed technique

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MANUAL SICS - INSTRUMENTATIONMANUAL SICS - INSTRUMENTATION

Non-machine dependent Non-machine dependent techniquetechnique

Needs only a simple irrigating Needs only a simple irrigating vectis or a spatulavectis or a spatula

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PHACOEMULSIFICATION- PHACOEMULSIFICATION- INSTRUMENTATIONINSTRUMENTATION

Money / MachineMoney / Machine dependent dependent techniquetechnique

Technical knowledge of machine Technical knowledge of machine parameters mustparameters must

Parameters are different for Parameters are different for different machinesdifferent machines

Training of OT paramedical staff Training of OT paramedical staff

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Manual SICS - Cost effectiveness Manual SICS - Cost effectiveness

No machine costNo machine cost No cost of reusablesNo cost of reusables Requires less fluids and Requires less fluids and

viscoelasticsviscoelastics High volume cheaper than ECCEHigh volume cheaper than ECCE

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Phacoemulsification-Phacoemulsification-Cost effectivenessCost effectiveness

Machine costMachine cost Cost of consumables eg. Phaco Cost of consumables eg. Phaco

tip, sleeve tubing, probetip, sleeve tubing, probe Requires more fluid and Requires more fluid and

viscoelasticsviscoelastics Problems of machine failure Problems of machine failure

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Average time of surgeryAverage time of surgery

Manual SICS – Manual SICS – 4 to 8 mts4 to 8 mts Not influenced by nucleus Not influenced by nucleus

hardnesshardness

PE technique - PE technique - 12 to 15 mts12 to 15 mts Dependent on type of cataractDependent on type of cataract

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Turnover of cases / hourTurnover of cases / hour

Phacoemulsification - Phacoemulsification - 4 to 5 cases4 to 5 cases

Manual SICS Manual SICS - - 14 to 15 cases14 to 15 cases

Ideal for large volume conversionIdeal for large volume conversion

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SURGICALLY INDUCED SURGICALLY INDUCED ASTIGMATISMASTIGMATISM

SIA between MSICS and Phaco SIA between MSICS and Phaco with rigid IOL - not statistically with rigid IOL - not statistically significantsignificant

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ConclusionConclusionManual SICS offers all the Manual SICS offers all the advantages of Phacoemulsificationadvantages of Phacoemulsification

Less induced astigmatismLess induced astigmatism Faster stabilisation of final Faster stabilisation of final

refractionrefraction Less tendency towards ATR shiftLess tendency towards ATR shift Comfortable postoperative period Comfortable postoperative period

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CONCLUSIONCONCLUSION

Manual Manual SICSSICS is superior to phacoemulsification is superior to phacoemulsification Easier to learnEasier to learn Cost effectiveCost effective Not machine dependentNot machine dependent Short procedureShort procedure Postoperative results comparable to PEPostoperative results comparable to PE Ideal alternative to ECCE with IOL for large Ideal alternative to ECCE with IOL for large

volume surgeryvolume surgery

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Manual Vs Instrumental PhacoManual Vs Instrumental Phaco

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