original study......unaided vision after MSICS

1. Unaided vision after manual
suture less small incision
cataract surgery (MSICS)
Dr Abdul Munim Khan
MBBS MCPS FCPS
Associate Professor & HOD
Ophthalmology
MBBS MC

2. Introduction:
• Prevalence of blindness in Pakistan is 2.7 %
• In Pakistan cataract is major cause of
blindness (51.5%) and also in the world
(47.8% or 17.7 million persons)

3. • Any opacity of crystalline lens of the eye is
called cataract
• Treatment is mainly surgery

4. • Phacoemulsification with foldable intra
ocular lens (IOL) is the gold standard
• MSICS, a new surgical technique is gaining
popularity as it is cheaper and less
technology dependant and gives almost equal
visual results as phaco

5. • This study was done to assess the efficacy of
MSICS by recording unaided vision four
weeks after operation, in our population

6. Material and methods:
• This study was done at a local NGO Eye
Hospital
• Informed consent was taken from all the
patients and permission was taken from the
hospital ethics committee for conducting the
study.

7. • 78 consecutive patients who reported for
follow up, four weeks after MSICS from 1 Jan
- 31 Mar 2012 were selected for the study
• Patients were followed up on first post
operative day, then at 2 weeks and finally at
four weeks and four weeks the unaided
vision was especially recorded

8. Inclusion and exclusion criteria:
• Patients in whom cataract was the main cause
of visual impairment were included in the
study.
• Patients having uncontrolled diabetes and
hypertension were excluded from the study.
• The data was collected on pre designed
proforma and analyzed on SPSS 17

9. • Scs
Steps Of Surgery
1. Frown Incision 2. Scleral Tunnel 3. Capulorrexhis
4. 5. Manual cracking of nucleus into two 6. Prolapse of heminucleus in AC

10. 7-8. Delivery of heminucleus 9-10. size main wound 5.5 mm
11. IOL 12. Implantation of IOL

11. 13. Dialing of IOL Into the Bag 14. Hydration of side-port

12. Results:
• Out of total 78 patients, 49 (62.82%) were
females and 29 (37.12%) were males.
• Ages ranged from 25-88 years (average 63.65
years)

13. Pre-operative BCVA (%)
• 6/24-6/60 35 (44.87)
• Less than 6/60 41 (52.56)

14. Post Operative Unaided Visual
Acuity
Uncorrected
vision
Patient
number
percentage
6/6 23 29.4
6/9 26 33.3
6/12 19 24.3
6/18 2 2.5
6/24 4 5.1
6/36 1 1.2
6/60 3 3.8
Less than 6/60 0 0

15. Astigmatism (SIA)
Pre operative 0.99 Diopters
Post operative 1.11 Diopters
SIA 0.12 Diopters

16. Results according to WHO
standards
Visual Acuity Post-operative
UCVA (%)
Good 6/18-6/6 70 (89.74)
Moderate 6/60 -6/24 10 (12.82)
Poor < 6/60 0 (0)

17. • The treatment of cataract is cataract extraction
• The main objectives of modern cataract
surgery
1. better unaided vision
2. rapid post surgical recovery
3. minimal complications
Discussion

18. • Two types of cataract surgery are performed
worldwide;
• 1. Extra Capsular Cataract Extraction with
Intra Ocular Lens (ECCE with IOL)
• 2. Phacoemulsification with foldable IOL

19. • MSICS, a new surgical technique is gaining
popularity as it is cheaper and less
technology dependant and gives almost equal
visual results as phaco

20. • various studies show that:
• visual results of Phacoemulsification are better than
ECCE (Zawar and Gogate, 2011 )
• visual results of MSICS are better than ECCE.
• (Gilbert et al 2011)(Pershing and Kumar 2007) (Zia,
Raza and Ali, 2010)
• MSICS is almost equal to Phacoemulsification and
even better than phaco (Ruit et al 2007)

21. Recommendation of WHO regarding
outcome of any cataract surgery
After surgery vision may be Good (6/6-6/18)
borderline and poor (<6/60)
Recommendation of WHO
Good uncorrected visual acuity in at least 80% and poor
outcome in less than 5% of patients

22. • In this study, nearly 90% of patients attained
good unaided post op vision this is 10% more
than the recommendation by WHO.
• Study by Ruit S et al in 2007 in Nepal also
achieved similar results .

23. Excellent unaided vision in MSICS
is due to
• Small incision 5.5-7.00 mm as opposed to 10-
12 mm in ECCE
• Scleral tunnel leading to self sealing incision
requiring no sutures
• Astigmatically neutral location of the main
incision

24. Additional factors in this study
1. good pre operative evaluation
2. accurate biometry
3. construction of an optimal self sealing and almost
astigmatically neutral sclera tunnel (SIA only 0.12
Diopters)
4. placement of IOL in the bag and
5. single experienced surgeon (author)

25. •MSICS may preferred to phaco
due the following reasons
1. Almost equal visual results
2. Very high Cost of phaco machine,
phaco related consumables and
maintenance
3. longer learning curve of Phaco
4. Use of expensive foldable IOLs in
Phaco
5. Longer operative time of Phaco

26. • Hence in developing countries like Pakistan
MSICS maybe preferred method to carry out
high volume and relatively cheap cataract
surgery

27. Conclusion:
1. MSICS achieved excellent unaided visual outcome,
90% achieved good unaided vision.
2. It is highly effective in the rehabilitation of cataract
patients.
3. Hence it is highly recommended especially for high
volume cataract surgery in developing countries like
Pakistan.

28. References
1. Jadoon MZ, Dineen B, Bourne RR, Shah SP, Khan MA, Johnson GJ, Gilbert CE,
Khan MD. Prevalence of blindness and visual impairment in Pakistan: the
Pakistan National Blindness and Visual Impairment Survey. Invest Ophthalmol
Vis Sci. 2006 Nov;47(11):4749-55.
2. Resnikoff S, Pascolini D, Etya'ale D. et al. Global data on visual impairment in
the year 2002. Bull World Health Organ 2004. 82844–851.851.
3. Dineen B, Bourne RR, Jadoon Z, Shah SP, Khan MA, Foster A, Gilbert CE, Khan
MD. Causes of blindness and visual impairment in Pakistan. The Pakistan
national blindness and visual impairment survey. Pakistan National Eye Survey
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4. Sajjad Haider, Arif Hussain, Hans Limburg Cataract blindness in Chakwal
District , Pakistan : results of a survey.. Ophthalmic Epidemiology 2003, Vol.10,
No.4, pp. 249-258
5. Asoke Garg et al.master’s guide to manual small incision cataract surgery
MSICS. 2009; 1STEdition: 3
6. Rajesh Sinha, Prakashchand Agarwal, Chandrashekhar Kumar R. P. Centre for
Ophthalmic Sciences, All India Institute of Medical Sciences, Ansari Nagar, New
Delhi, India Small incision cataract surgery: Review of journal abstracts
Year:2009 Volume: 57Issue:1Page : 79-82
7. Zawar, S.V., Gogate, P. Safety and efficacy of temporal manual small incision
cataract surgery in India. European Journal of Ophthalmology. 2011; 21(6): 748-
753

29. 8 Sohail Zia, Ali Raza, S Imtiaz Ali. Comparison of Small Incision Cataract
Surgery with Extra Capsular Cataract Extraction.Journal of Rawalpindi
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10 Suzann Pershing, Abha Kumar. Phacoemulsification versus extracapsular
cataract extraction: where do we stand? : Current Opinion in
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11 Ruit, S. et al. Am J Ophthalmol2007; 143(1):32–38
12 Editorial WHO Guidelines and Recommendations for the Post-operative
Outcome of Cataract Surgery with IOL. Community Eye Health Vol 16 No.
48 2003 pp49-51 l
13 Gogate et al. Extracapsular cataract surgery compared with manual small
incision cataract surgery in community eye care setting in western India: a
randomised controlled trial.Br J Ophthalmol. 2003 June; 87(6): 667–672.
14 Shen, L.-X., Cai, J.-L., Huang, C.-L., Guo, J. Comparison of the efficacy of
extracapsular cataract extraction combined with intraocular lens
implantation by two kinds of converse frown and trapezoidal scleral small
incision. International Journal of Ophthalmology. 2010; 10(6): 1061-1063

30. Thank You