Transcript Efficacy od serratiopepdidase in prevention of fibrin

Manual Vs Instrumental
Phaco
Dr. Navin Gupta M.S. (Ophthal)
ARAVIND EYE HOSPITALS
& Postgraduate Institute of Ophthalmology
SMALL INCISION CATARACT
SURGERY
 Main objective in modern cataract surgery
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Better unaided visual acuity
Rapid post-op surgical recovery
Minimal surgery related complications
Achieved by reducing the incision size
A R A V I N D E Y E H O S P I T A L S
TECHNIQUE OF MANUAL SICS
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Scleral tunnel
Corneal valve incision
AC entry with keratome
Capsulotomy & Hydrodissection
Prolapse of nucleus into AC
Nucleus delivery with irrigating vectis
I/A of cortex
IOL implantation
A R A V I N D E Y E H O S P I T A L S
TECHNIQUE OF
PHACOEMULSIFICATION
 Scleral tunnel
 Corneal valve incision
 AC entry with keratome
 Capsulotomy & Hydrodissection
(Capsulorrhexis)
 Divide & conquer or phaco chop
technique
 I/A of cortex
 IOL implantation
A R A V I N D E Y E H O S P I T A L S
INDICATIONS
 Universally applicable to all cataracts
 Ideal in following cases
 Following RD / Vitrectomy
procedures
 Glaucoma
 Traumatic Cataracts
 Patients with Colobomas
A R A V I N D E Y E H O S P I T A L S
CONTRA-INDICATIONS
Mainly relative
 Black cataracts
 Brown cataracts
 Deep sockets
 Small hyperopic eyes
 Small pupil /PXF
 Subluxated / dislocated lens
A R A V I N D E Y E H O S P I T A L S
Manual SICS - Learning curve
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Easier and shorter
Rhexis or can-opener capsulotomy
Hydrodissection not mandatory
Minimal risk of nucleus drop
Hand- foot coordination not required
Single -handed technique
A R A V I N D E Y E H O S P I T A L S
Phaco- Learning curve
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Tougher & longer
Rhexis is a must
Hydrodissection is important
Risk of nuclear drop common
Hand foot coordination is necessary
Mostly two handed technique
A R A V I N D E Y E H O S P I T A L S
MANUAL SICS - INSTRUMENTATION
 Non-machine dependent
technique
 Needs only a simple irrigating
vectis or a spatula
A R A V I N D E Y E H O S P I T A L S
PHACOEMULSIFICATIONINSTRUMENTATION
 Money / Machine dependent
technique
 Technical knowledge of machine
parameters must
 Parameters are different for
different machines
 Training of OT paramedical staff
A R A V I N D E Y E H O S P I T A L S
Manual SICS - Cost effectiveness
 No machine cost
 No cost of reusables
 Requires less fluids and
viscoelastics
 High volume cheaper than ECCE
A R A V I N D E Y E H O S P I T A L S
PhacoemulsificationCost effectiveness
 Machine cost
 Cost of consumables eg. Phaco
tip, sleeve tubing, probe
 Requires more fluid and
viscoelastics
 Problems of machine failure
A R A V I N D E Y E H O S P I T A L S
Average time of surgery
Manual SICS – 4 to 8 mts
 Not influenced by nucleus
hardness
PE technique - 12 to 15 mts
 Dependent on type of cataract
A R A V I N D E Y E H O S P I T A L S
Turnover of cases / hour
 Phacoemulsification - 4 to 5 cases
 Manual SICS - 14 to 15 cases
Ideal for large volume conversion
A R A V I N D E Y E H O S P I T A L S
SURGICALLY INDUCED
ASTIGMATISM
 SIA between MSICS and Phaco
with rigid IOL - not statistically
significant
A R A V I N D E Y E H O S P I T A L S
Conclusion
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Manual SICS offers all the
advantages of Phacoemulsification
Less induced astigmatism
Faster stabilisation of final
refraction
Less tendency towards ATR shift
Comfortable postoperative period
A R A V I N D E Y E H O S P I T A L S
CONCLUSION
Manual SICS is superior to phacoemulsification
 Easier to learn
 Cost effective
 Not machine dependent
 Short procedure
 Postoperative results comparable to PE
 Ideal alternative to ECCE with IOL for large
volume surgery
A R A V I N D E Y E H O S P I T A L S
Manual Vs Instrumental Phaco
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A R A V I N D E Y E H O S P I T A L S