Endothelial Cell Loss and Surgically Induced Astigmatism After Sutureless Large-Incision Manual Cataract Extraction (SLIMCE)

Abstract

Objectives:To describe a modified manual cataract extraction technique, sutureless large-incision manual cataract extraction (SLIMCE), and to report its clinical outcomes.Methods: Case notes of 50 consecutive patients with cataract surgery performed using the SLIMCE technique were retrospectively reviewed. Clinical outcomes 3 months after surgery were analyzed, including postoperative uncorrected visual acuity, best-corrected visual acuity, intraoperative and postoperative complications, endothelial cell loss, and surgically induced astigmatism using the vector analysis method.Results: At the 3-month follow-up, all 50 patients had postoperative best-corrected visual acuity of at least 20/60, and 37 patients (74%) had visual acuity of at least 20/30. Uncorrected visual acuity was at least 20/68 in 28 patients (56%) and was between 20/80 and 20/200 in 22 patients (44%). No significant intraoperative complications were encountered, and sutureless wounds were achieved in all but 2 patients. At the 3-month followup, endothelial cell loss was 3.9%, and the mean surgically induced astigmatism was 0.69 diopter.Conclusions: SLIMCE is a safe and effective manual cataract extraction technique with low rates of surgically induced astigmatism and endothelial cell loss. In view of its low cost, SLIMCE may have a potential role in reducing cataract blindness in developing countries.

Extra Large Temporal Tunnel Cataract Extraction [ETCE]

“…The SIA can be reduced by placing the incision farthest from cornea. This can be achieved by shifting to temporal site [6,7], placing incision more posteriorly on sclera and also shifting the inner entry posteriorly as we did in our cases.…”

“…The outer incision is frown with more posterior location, bringing it nearer to the astigmatic funnel. The SLIMCE incision demonstrated by Lam et al, [7] is 8mm externally and 9-10 mm internally, but extends into cornea for 2mm which results in higher SIA (0.69D) than ETCE incision (0.32D). SIA in both the studies is calculated using Holladay technique and hence comparable.…”

“…Junsuke called tunnel of length 5.5 to 7 mm as "relatively large incision" [6]. Larger tunnel of size upto 8mm is considered "large incision" [7]. Large tunnel incision is needed in various settings like hard nucleus, poor mydriasis, pseudoexfoliation, mature or hypermature cataract, subluxated lens, compromised endothelium, etc to facilitate manipulation and easy delivery of nucleus.…”

Combined Topical-Intracameral Anesthesia in Manual Small-Incision Cataract Surgery

“…2 Because the surgical technique is improving, there is a general trend toward smaller incisions and less invasive maneuvers in MSICS. This has been accompanied over the last year by a renewed interest in topical anesthetic techniques, 18,19,22 which in many cases enhance the patient's comfort and reduce the inherent risks of retrobulbar and peribulbar injection. Topical anesthesia has the potential to serve as a safe, economic, and easy technique for MSICS.…”

Project vision: a new and sustainable model for eliminating cataract blindness in China

“…An anterior chamber (AC) maintainer is used to facilitate delivery of the nucleus 14 . Additional surgical details can be found in an upcoming publication 15 . The key potential advantages include lower capital and procedural costs and possibly, a shorter learning curve compared with phaco.…”