Phaco, small incision now more common in developing countries

SINGAPORE — Phacoemulsification and small incision cataract surgery are becoming more common in places like Nepal, said one physician from that country.

“I see [small incision cataract surgery] with temporal incision as a strong surgical technique coming up in this part of the world,” Sanduk Ruit, MD, told attendees of the Asia-Pacific Academy of Ophthalmology meeting.

Phaco with foldable IOL implantation is also gaining in popularity, “but we need to address cost factors, training factors and equipment,” he said. “Equipment must be more robust.”

Over the past 10 years, Dr. Ruit and his colleagues at the Tilganga Eye Center developed a sutureless cataract technique. He said they remove the entire cataract through a triangular capsulorrhexis they construct with a straight needle.

“You must make the rhexis larger than you would need with phaco to extract the whole nucleus,” he said.

The nucleus is extracted from the eye in two steps, he said, first delivering it into the anterior chamber of the eye and then extracting it from the eye by temporal section. Dr. Ruit said one of the technique’s advantages is that the surgeon sits in one place throughout the procedure.

In Nepal, Dr. Ruit said physicians are creating strict guidelines for local ophthalmologists’ training on these types of procedures.

“Microsurgical training should be continuous, wet lab and hands on,” he said. “There should also be mandatory training for 1 year before [trainees] can perform it.”

Dr. Ruit said his Tilganga Eye Center has improved patient flow and treats more difficult cataract cases than some other eye clinics in Nepal. In an effort to treat all patients, Dr. Ruit said his facility uses one physician and five support personnel, a reverse model from the common practice in Nepal. Too many physicians with not enough support staff is “very inefficient,” he said.

“Think of achievable models and don’t get overwhelmed,” he said.