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Manual technique may be superior to phaco for dense cataracts
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BEIJING — A manual small-incision cataract extraction technique may be superior to phaco when it comes to rock-hard cataracts, according to a surgeon speaking here.
At the 25th APAO Congress Subspecialty Day here, Ravindran Ravilla, MD, presented results of the White Cataract Study showing numerous advantages for performing a manual small-incision cataract extraction technique (MSICS) over phacoemulsification in cases of dense cataracts.
In the study, surgical time for phaco in dense cataracts was 15.5 minutes vs. 9 minutes for MSICS, and capsular rupture occurred in 2.2% of phaco cases compared with 1.4% in MSICS, Dr. Ravilla said. Uncorrected visual acuity and induced astigmatism were slightly better in the phaco group vs. the MSICS group, however, he said.
"Because MSICS is a faster technique that is less expensive, MSICS is more the appropriate technique for advanced, hard cataracts," Dr. Ravilla said.
Dr. Ravilla also noted that there was less corneal edema and quicker visual recovery in the MSICS group.
One thing about the density of the lens and how challenging it makes phaco, and that wasn’t obvious to me until I was doing it, was how challenging the visibility is. In phaco when you’re sculpting and chopping you have to see really well. And with these eyes, you have less than ideal operating conditions, and the visibility for me was difficult with these dense nuclei. I had to use dyes a lot and it was very difficult to do the rhexis. So that’s something again that’s not as obvious that has as much to do with the patient population as the condition.
– David F. Chang, MD
OSN Cataract Surgery
Board Member