1 / 18

Manual Vs Instrumental Phaco

Manual Vs Instrumental Phaco. Dr. Navin Gupta M.S. (Ophthal). SMALL INCISION CATARACT SURGERY. Main objective in modern cataract surgery Better unaided visual acuity Rapid post-op surgical recovery Minimal surgery related complications Achieved by reducing the incision size .

amish
Download Presentation

Manual Vs Instrumental Phaco

An Image/Link below is provided (as is) to download presentation Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author. Content is provided to you AS IS for your information and personal use only. Download presentation by click this link. While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server. During download, if you can't get a presentation, the file might be deleted by the publisher.

E N D

Presentation Transcript

  1. Manual Vs Instrumental Phaco Dr. Navin Gupta M.S. (Ophthal)

  2. SMALL INCISION CATARACT SURGERY • Main objective in modern cataract surgery • Better unaided visual acuity • Rapid post-op surgical recovery • Minimal surgery related complications Achieved by reducing the incision size

  3. TECHNIQUE OF MANUAL SICS • 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

  4. 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

  5. INDICATIONS • Universally applicable to all cataracts • Ideal in following cases • Following RD / Vitrectomy procedures • Glaucoma • Traumatic Cataracts • Patients with Colobomas

  6. CONTRA-INDICATIONS Mainly relative • Black cataracts • Brown cataracts • Deep sockets • Small hyperopic eyes • Small pupil /PXF • Subluxated / dislocated lens

  7. Manual SICS - Learning curve • Easier and shorter • Rhexis or can-opener capsulotomy • Hydrodissection not mandatory • Minimal risk of nucleus drop • Hand- foot coordination not required • Single -handed technique

  8. Phaco- Learning curve • Tougher & longer • Rhexis is a must • Hydrodissection is important • Risk of nuclear drop common • Hand foot coordination is necessary • Mostly two handed technique

  9. MANUAL SICS - INSTRUMENTATION • Non-machine dependent technique • Needs only a simple irrigating vectis or a spatula

  10. PHACOEMULSIFICATION- INSTRUMENTATION • Money / Machine dependent technique • Technical knowledge of machine parameters must • Parameters are different for different machines • Training of OT paramedical staff

  11. Manual SICS - Cost effectiveness • No machine cost • No cost of reusables • Requires less fluids and viscoelastics • High volume cheaper than ECCE

  12. Phacoemulsification-Cost effectiveness • Machine cost • Cost of consumables eg. Phaco tip, sleeve tubing, probe • Requires more fluid and viscoelastics • Problems of machine failure

  13. 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

  14. Turnover of cases / hour • Phacoemulsification - 4 to 5 cases • Manual SICS - 14 to 15 cases Ideal for large volume conversion

  15. SURGICALLY INDUCED ASTIGMATISM • SIA between MSICS and Phaco with rigid IOL - not statistically significant

  16. Conclusion Manual SICS offers all the advantages of Phacoemulsification • Less induced astigmatism • Faster stabilisation of final refraction • Less tendency towards ATR shift • Comfortable postoperative period

  17. 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

  18. Manual Vs Instrumental Phaco  $ $

More Related