Abandoned Phacoemulsification Surgery: Convert to No-Stitch Non-Phaco Manual Small-Incision Cataract Surgery
Complications do occur in phacoemulsification surgery for many reasons. Sometimes, the surgeons convert phaco to extracapsular cataract extraction (ECCE) for the patients safety. The closed chamber situation is then compromised, and problems of suturing are also there. But if the surgeon converts it to no-stitch manual small-incision cataract surgery (SICS), the wound integrity will remain and rehabilitation will be much faster. This course will teach the basics of an effective no-stitch manual SICS, which is crucial when complications are faced during phacoemulsification surgery.
At the conclusion of this video-based course, the cataract surgeon will be able to understand (1) the indications of primary no-stitch manual SICS technique in most difficult situations, (2) how to perform no-stitch manual SICS, step by step, (3) conversion of abandoned phaco to no-stitch manual SICS, and (4) how to deal with complications of no-stitch manual SICS if they occur.
Summary of Content/Synopsis of the course
1. Introduction: Phaco versus Sutureless manual Small Incision Cataract Surgery (SICS)
2. Abandoned Phaco: Why do we need to convert?
- Patient factors
- Surgeon factors
- Machine factors
3. Conversion: The important causes
4. Abandoned Phaco: How do we convert?
- Convert to conventional ECCE PCIOL and 4-6 stitches to close the wound;
- The disadvantages of conventional ECCE with sutures
- Convert to sutureless Manual SICS
5. Manual SICS
- Its advantages
- Different techniques of nuclear management in Manual SICS
6. Basic steps of conversion
- Fornix-based conjunctival flap
- Funnel-shaped sclerocorneal incision
- Enlargement of rhexis.
- Adequate dispersive viscoelastics are required in every step
- Nuclear prolapsed into anterior chamber
- Nucleus delivery by: irrigating vectis or by phaco section by wire snare techniques
- Cortical cleaning: either by By Siemco canula or via bimanual automated I/A cannula
- IOL placement: adequate viscoelastics ; better by injector system;
- Better to use 3-piece IOL, if rhexis is lost, so as to place the lens in-the-sulcus
7. Practical examples in different case scenario
- Runaway rhexis
- Posterior capsule blowout during hydroprocedure
- Suprahard black cataract
- Small pupil with hard cataract
- PC Rent during fragment removal
- Subluxation with hard cataract
8. Concluding remarks
[ Keyword ]
Abandon Phacoemulsification Surgery / Manual Small incision cataract surgery / No-stitch / Conversion
[ Conflict of Interest ]