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

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Presentation on theme: "Manual Vs Instrumental Phaco Dr. Navin Gupta M.S. (Ophthal)"— Presentation transcript:

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

2 SMALL INCISION CATARACT SURGERY Main objective in modern cataract surgery Main 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

3 TECHNIQUE OF MANUAL SICS Scleral tunnel Scleral tunnel Corneal valve incision Corneal valve incision AC entry with keratome AC entry with keratome Capsulotomy & Hydrodissection Capsulotomy & Hydrodissection Prolapse of nucleus into AC Prolapse of nucleus into AC Nucleus delivery with irrigating vectis Nucleus delivery with irrigating vectis I/A of cortex I/A of cortex IOL implantation IOL implantation

4 TECHNIQUE OF PHACOEMULSIFICATION Scleral tunnel Scleral tunnel Corneal valve incision Corneal valve incision AC entry with keratome AC entry with keratome Capsulotomy & Hydrodissection Capsulotomy & Hydrodissection(Capsulorrhexis) Divide & conquer or phaco chop technique Divide & conquer or phaco chop technique I/A of cortex I/A of cortex IOL implantation IOL implantation

5 INDICATIONS Universally applicable to all cataracts Universally applicable to all cataracts Ideal in following cases Ideal in following cases Following RD / Vitrectomy procedures Following RD / Vitrectomy procedures Glaucoma Glaucoma Traumatic Cataracts Traumatic Cataracts Patients with Colobomas Patients with Colobomas

6 CONTRA-INDICATIONS Mainly relative Black cataracts Black cataracts Brown cataracts Brown cataracts Deep sockets Deep sockets Small hyperopic eyes Small hyperopic eyes Small pupil /PXF Small pupil /PXF Subluxated / dislocated lens Subluxated / dislocated lens

7 Manual SICS - Learning curve Easier and shorter Easier and shorter Rhexis or can-opener capsulotomy Rhexis or can-opener capsulotomy Hydrodissection not mandatory Hydrodissection not mandatory Minimal risk of nucleus drop Minimal risk of nucleus drop Hand- foot coordination not required Hand- foot coordination not required Single -handed technique Single -handed technique

8 Phaco- Learning curve Tougher & longer Tougher & longer Rhexis is a must Rhexis is a must Hydrodissection is important Hydrodissection is important Risk of nuclear drop common Risk of nuclear drop common Hand foot coordination is necessary Hand foot coordination is necessary Mostly two handed technique Mostly two handed technique

9 MANUAL SICS - INSTRUMENTATION Non-machine dependent technique Non-machine dependent technique Needs only a simple irrigating vectis or a spatula Needs only a simple irrigating vectis or a spatula

10 PHACOEMULSIFICATION- INSTRUMENTATION Money / Machine dependent technique Money / Machine dependent technique Technical knowledge of machine parameters must Technical knowledge of machine parameters must Parameters are different for different machines Parameters are different for different machines Training of OT paramedical staff Training of OT paramedical staff

11 Manual SICS - Cost effectiveness No machine cost No machine cost No cost of reusables No cost of reusables Requires less fluids and viscoelastics Requires less fluids and viscoelastics High volume cheaper than ECCE High volume cheaper than ECCE

12 Phacoemulsification- Cost effectiveness Machine cost Machine cost Cost of consumables eg. Phaco tip, sleeve tubing, probe Cost of consumables eg. Phaco tip, sleeve tubing, probe Requires more fluid and viscoelastics Requires more fluid and viscoelastics Problems of machine failure Problems of machine failure

13 Average time of surgery Manual SICS – 4 to 8 mts Not influenced by nucleus hardness Not influenced by nucleus hardness PE technique - 12 to 15 mts Dependent on type of cataract Dependent on type of cataract

14 Turnover of cases / hour Phacoemulsification - 4 to 5 cases Phacoemulsification - 4 to 5 cases Manual SICS - 14 to 15 cases Manual SICS - 14 to 15 cases Ideal for large volume conversion

15 SURGICALLY INDUCED ASTIGMATISM SIA between MSICS and Phaco with rigid IOL - not statistically significant SIA between MSICS and Phaco with rigid IOL - not statistically significant

16 Conclusion Manual SICS offers all the advantages of Phacoemulsification Less induced astigmatism Less induced astigmatism Faster stabilisation of final refraction Faster stabilisation of final refraction Less tendency towards ATR shift Less tendency towards ATR shift Comfortable postoperative period Comfortable postoperative period

17 CONCLUSION Manual SICS is superior to phacoemulsification Easier to learn Easier to learn Cost effective Cost effective Not machine dependent Not machine dependent Short procedure Short procedure Postoperative results comparable to PE Postoperative results comparable to PE Ideal alternative to ECCE with IOL for large volume surgery Ideal alternative to ECCE with IOL for large volume surgery

18 Manual Vs Instrumental Phaco $ $


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