Abstract
Manual Small Incision Cataract Surgery (MSICS) is a variant of extracapsular cataract surgery (ECCE), the important differences being construction of a self-sealing scleral tunnel wound, capsulorhexis, in-toto prolapse of nucleus through capsulorhexis into anterior chamber, and delivering it out of the eye in a closed chamber state. The surgical steps require considerable manual dexterity. Like any other surgical procedure, MSICS is also associated with complications and some of these are unique to this surgical procedure. A good understanding of these complications and management will go a long way in ensuring vision restoration in these patients. In this chapter we will be discussing medical therapy including pre-, peri-, and postoperative care of patients undergoing MSICS as well as complications and their management.
Financial Disclosure
None of the authors have any financial interest in the subject matter discussed in this chapter.
This is a preview of subscription content, log in via an institution.
Buying options
Tax calculation will be finalised at checkout
Purchases are for personal use only
Learn about institutional subscriptionsReferences
Speaker MG, Menikoff JA. Prophylaxis of endophthalmitis with topical povidone-iodine. Ophthalmology. 1991;98(12):1769–75.
Yu CQ, Ta CN. Prevention of postcataract endophthalmitis: evidence-based medicine. Curr Opin Ophthalmol. 2012;23(1):19–25.
Shimada H, et al. Reduction of anterior chamber contamination rate after cataract surgery by intraoperative surface irrigation with 0.25% povidone-iodine. Am J Ophthalmol. 2011;151(1):11–7 e1.
Apt L, et al. The effect of povidone-iodine solution applied at the conclusion of ophthalmic surgery. Am J Ophthalmol. 1995;119(6):701–5.
Ram J, et al. Prevention of postoperative infections in ophthalmic surgery. Indian J Ophthalmol. 2001;49(1):59–69.
Endophthalmitis Study Group, European Society of Cataract & Refractive Surgeons. Prophylaxis of postoperative endophthalmitis following cataract surgery: results of the ESCRS multicenter study and identification of risk factors. J Cataract Refract Surg. 2007;33(6):978–88.
O’Brien TP, Arshinoff SA, Mah FS. Perspectives on antibiotics for postoperative endophthalmitis prophylaxis: potential role of moxifloxacin. J Cataract Refract Surg. 2007;33(10):1790–800.
Galvis V, et al. Cohort study of intracameral moxifloxacin in postoperative endophthalmitis prophylaxis. Ophthalmol Eye Dis. 2014;6:1–4.
Matsuura K, et al. Efficacy and safety of prophylactic intracameral moxifloxacin injection in Japan. J Cataract Refract Surg. 2013;39(11):1702–6.
Matsuura K, et al. Comparison between intracameral moxifloxacin administration methods by assessing intraocular concentrations and drug kinetics. Graefes Arch Clin Exp Ophthalmol. 2013;251(8):1955–9.
Gogate PM, et al. Safety and efficacy of phacoemulsification compared with manual small-incision cataract surgery by a randomized controlled clinical trial: six-week results. Ophthalmology. 2005;112(5):869–74.
Riaz Y, de Silva SR, Evans JR. Manual small incision cataract surgery (MSICS) with posterior chamber intraocular lens versus phacoemulsification with posterior chamber intraocular lens for age-related cataract. Cochrane Database Syst Rev. 2013;(10):CD008813.
Ruit S, et al. A prospective randomized clinical trial of phacoemulsification vs manual sutureless small-incision extracapsular cataract surgery in Nepal. Am J Ophthalmol. 2007;143(1):32–8.
Gogate PM. Small incision cataract surgery: complications and mini-review. Indian J Ophthalmol. 2009;57(1):45–9.
Adekoya BJ, et al. Current practice of ophthalmic anesthesia in Nigeria. Middle East Afr J Ophthalmol. 2013;20(4):341–4.
Hay A, et al. Needle penetration of the globe during retrobulbar and peribulbar injections. Ophthalmology. 1991;98(7):1017–24.
Schrader WF, et al. Risks and sequelae of scleral perforation during peribulbar or retrobulbar anesthesia. J Cataract Refract Surg. 2010;36(6):885–9.
Berglin L, Stenkula S, Algvere PV. Ocular perforation during retrobulbar and peribulbar injections. Ophthalmic Surg Lasers. 1995;26(5):429–34.
Ahmed S, Grayson MC. Retrobulbar haemorrhage: when should we operate? Eye (Lond). 1994;8(Pt 3):336–8.
Edge KR, Nicoll JM. Retrobulbar hemorrhage after 12,500 retrobulbar blocks. Anesth Analg. 1993;76(5):1019–22.
Rubin AP. Complications of local anaesthesia for ophthalmic surgery. Br J Anaesth. 1995;75(1):93–6.
Kumar CM. Orbital regional anesthesia: complications and their prevention. Indian J Ophthalmol. 2006;54(2):77–84.
Katsev DA, Drews RC, Rose BT. An anatomic study of retrobulbar needle path length. Ophthalmology. 1989;96(8):1221–4.
Unsold R, Stanley JA, DeGroot J. The CT-topography of retrobulbar anesthesia. Anatomic-clinical correlation of complications and suggestion of a modified technique. Albrecht Von Graefes Arch Klin Exp Ophthalmol. 1981;217(2):125–36.
Liu C, Youl B, Moseley I. Magnetic resonance imaging of the optic nerve in extremes of gaze. Implications for the positioning of the globe for retrobulbar anaesthesia. Br J Ophthalmol. 1992;76(12):728–33.
Riad W, Akbar F. Ophthalmic regional blockade complication rate: a single center audit of 33,363 ophthalmic operations. J Clin Anesth. 2012;24(3):193–5.
Hamed LM. Strabismus presenting after cataract surgery. Ophthalmology. 1991;98(2):247–52.
Ropo A, Ruusuvaara P, Nikki P. Ptosis following periocular or general anaesthesia in cataract surgery. Acta Ophthalmol (Copenh). 1992;70(2):262–5.
Levy J, Lifshitz T. Lidocaine hypersensitivity after subconjunctival injection. Can J Ophthalmol. 2006;41(2):204–6.
Delaere L, et al. Allergic reaction to hyaluronidase after retrobulbar anaesthesia: a case series and review. Int Ophthalmol. 2009;29(6):521–8.
Jackson D, Chen AH, Bennett CR. Identifying true lidocaine allergy. J Am Dent Assoc. 1994;125(10):1362–6.
Haldipurkar SS, Shikari HT, Gokhale V. Wound construction in manual small incision cataract surgery. Indian J Ophthalmol. 2009;57(1):9–13.
Gimbel HV, Neuhann T. Development, advantages, and methods of the continuous circular capsulorhexis technique. J Cataract Refract Surg. 1990;16(1):31–7.
Vasavada A, Desai J. Capsulorhexis: its safe limits. Indian J Ophthalmol. 1995;43(4):185–90.
Thim K, Krag S, Corydon L. Stretching capacity of capsulorhexis and nucleus delivery. J Cataract Refract Surg. 1991;17(1):27–31.
Malik KP, Goel R. Nucleus management with Blumenthal technique: anterior chamber maintainer. Indian J Ophthalmol. 2009;57(1):23–5.
Jain R, et al. Anatomic and visual outcomes of descemetopexy in post-cataract surgery descemet’s membrane detachment. Ophthalmology. 2013;120(7):1366–72.
Chaurasia S, Ramappa M, Garg P. Outcomes of air descemetopexy for Descemet membrane detachment after cataract surgery. J Cataract Refract Surg. 2012;38(7):1134–9.
George R, et al. Comparison of endothelial cell loss and surgically induced astigmatism following conventional extracapsular cataract surgery, manual small-incision surgery and phacoemulsification. Ophthalmic Epidemiol. 2005;12(5):293–7.
Ganekal S, Nagarajappa A. Comparison of morphological and functional endothelial cell changes after cataract surgery: phacoemulsification versus manual small-incision cataract surgery. Middle East Afr J Ophthalmol. 2014;21(1):56–60.
Guzek JP, Ching A. Small-incision manual extracapsular cataract surgery in Ghana, West Africa. J Cataract Refract Surg. 2003;29(1):57–64.
Das T. National endophthalmitis survey. Indian J Ophthalmol. 2003;51(2):117–8.
Haripriya A, et al. Complication rates of phacoemulsification and manual small-incision cataract surgery at Aravind Eye Hospital. J Cataract Refract Surg. 2012;38(8):1360–9.
Pathengay A, et al. Endophthalmitis outbreaks following cataract surgery: causative organisms, etiologies, and visual acuity outcomes. J Cataract Refract Surg. 2012;38(7):1278–82.
Sharma YR, Gaur A, Azad RV. Suprachoroidal haemorrhage. Secondary management. Indian J Ophthalmol. 2001;49(3):191–2.
Kuhn F, Morris R, Mester V. Choroidal detachment and expulsive choroidal hemorrhage. Ophthalmol Clin North Am. 2001;14(4):639–50.
Eriksson A, et al. Risk of acute suprachoroidal hemorrhage with phacoemulsification. J Cataract Refract Surg. 1998;24(6):793–800.
Blumenthal M, Grinbaum A, Assia EI. Preventing expulsive hemorrhage using an anterior chamber maintainer to eliminate hypotony. J Cataract Refract Surg. 1997;23(4):476–9.
Spaeth GL. Suprachoroidal hemorrhage: no longer a disaster. Ophthalmic Surg. 1987;18(5):329–30.
Saxena S, et al. Management of vitreous haemorrhage. Indian J Ophthalmol. 2003;51(2):189–96.
Krishnan MM, Baskaran RK. Management of postoperative choroidal detachment. Indian J Ophthalmol. 1985;33(4):217–20.
Haug SJ, Bhisitkul RB. Risk factors for retinal detachment following cataract surgery. Curr Opin Ophthalmol. 2012;23(1):7–11.
Tielsch JM, et al. Risk factors for retinal detachment after cataract surgery. A population-based case–control study. Ophthalmology. 1996;103(10):1537–45.
Coppe AM, Lapucci G. Posterior vitreous detachment and retinal detachment following cataract extraction. Curr Opin Ophthalmol. 2008;19(3):239–42.
Sivaprasad S, Bunce C, Wormald R. Non-steroidal anti-inflammatory agents for cystoid macular oedema following cataract surgery: a systematic review. Br J Ophthalmol. 2005;89(11):1420–2.
Ang M, Evans JR, Mehta JS. Manual small incision cataract surgery (MSICS) with posterior chamber intraocular lens versus extracapsular cataract extraction (ECCE) with posterior chamber intraocular lens for age-related cataract. Cochrane Database Syst Rev. 2012;(4):CD008811.
Mallik VK, et al. Comparison of astigmatism following manual small incision cataract surgery: superior versus temporal approach. Nepal J Ophthalmol. 2012;4(1):54–8.
Kongsap P. Visual outcome of manual small-incision cataract surgery: comparison of modified Blumenthal and Ruit techniques. Int J Ophthalmol. 2011;4(1):62–5.
Author information
Authors and Affiliations
Corresponding author
Editor information
Editors and Affiliations
Rights and permissions
Copyright information
© 2016 Springer International Publishing Switzerland
About this chapter
Cite this chapter
Roy, A., Garg, P. (2016). Post Operative Care in Manual Small Incision Cataract Surgery. In: Henderson, B. (eds) Manual Small Incision Cataract Surgery. Springer, Cham. https://doi.org/10.1007/978-3-319-24666-6_12
Download citation
DOI: https://doi.org/10.1007/978-3-319-24666-6_12
Published:
Publisher Name: Springer, Cham
Print ISBN: 978-3-319-24664-2
Online ISBN: 978-3-319-24666-6
eBook Packages: MedicineMedicine (R0)