Small Incision Cataract Surgery (SICS)
Title: Small Incision Cataract Surgery (SICS)
Authors: Russell Swan, MD; Jeff Pettey, MD
Keywords/Main Subjects: Hypermature cataract; SICS; Small incision cataract surgery
Diagnosis: Hypermature Cataract
This case is from a 72 year old women who presented with a hypermature cataract and light perception with projection vision in the surgical video eye and count finger vision from a mature cataract in the other eye. She had no known history of trauma and her posterior segment was attached on ultrasound. After a discussion of the risks benefits and alternatives to surgery the patient elected to proceed with surgery. Given the significant density of her lens the decision was made to proceed with small incision cataract surgery (SICS) so as to better preserve her endothelium.
This video demonstrates one technique to SICS. It is important to note that for many steps of this surgery (capsulotomy, prolapse of nucleus into anterior chamber, prolapse of lens out of eye, conjunctival closure, ect) there are numerous techniques that have been described. In this case, given the time and resources available in our OR we elected to use trypan blue and create a large continuous curvilinear capsulorrhexis. We used bi-manual irrigation and aspiration which may not be available in all settings. In addition, conjunctival peritomy closure was achieved with dissolvable Vicryl suture as opposed to cautery or sub-conjunctival antibiotic injection.
The true key to this surgery lies in the architecture and construction of the shelved self-sealing scleral tunnel. This incision can be made tangential to the limbus or frown-shaped. The initial groove is ideally 33-50% depth, 6-7 mm in width, 1.5-2.0mm posterior to the limbus and carried 1-1.5mm into the clear cornea. It is trapezoid in shape to allow easy prolapse of the nucleus. A temporal approach counteracts most likely against the rule astigmatism in the elederly patient population and also provides easier access without having to worry about the brow.
It is important to note that Dr. Pettey performed the creation of the initial wound and Dr Swan performed the entirety of the rest of the case using whatever techniques he was most confortable with. This was Dr Swan’s first SICS case and highlights the fact that with a well created self-sealing incision the rest of the case can be comfortably completed.
Natchiar, G. Manual Small Incision Cataract Surgery 2nd edition. Arivand Eye Hospitals. Available as iBook free. 2004.
Ruit, S. et al. Standard Operating Procedure Manual for Modern Small Incision Cataract Surgery. Tilganga Eye Centre. Available as iBook free. 2006.
Tabin, G., Feilmeier, M. Cataract Surgery in the Developing World. Focal Points Clinical Modules for Ophthalmologists. Volume 29:9. September 2011
Faculty Approval by: Jeff Pettey, MD