Global preferred practice patterns in manual small incision cataract surgery

Abstract

Objectives: Manual small incision cataract surgery (MSICS) has become the surgery of choice in developing countries and setups with a high cataract load; being non-inferior to phacoemulsification, with minimum dependency on technology, and a shorter learning curve. There exist high variability and multiple differing personal preferences in its instrumentation and techniques. Through our study, we aimed to analyse different MSICS practice patterns across the globe to be able to summarise the commonly performed variations and carve a path for MSICS training programmes and help novice surgeons learn the state-of-the-art methods. Materials and Methods: Ours was an online, questionnaire-based cross-sectional observational study. The Google form was floated among ophthalmologists through social media, globally. The preferences for each step of MSICS from the type of anaesthesia used to post-operative advice were asked and responses analysed. Results: Out of 278 respondents, 234 (84.17%) ophthalmologists used peribulbar anesthesia; 214 (77.3%) preferred to do capsulorrhexis first followed by corneoscleral tunnel incision; 145 (52.15%) preferred frown incision; and 152 (54.7%) considered astigmatism management important during tunnel-making. The majority (226 [81.3%]) surgeons used anterior chamber maintainer. Viscoexpression, wire-Vectis, and irrigating Vectis were practiced by 122 (43.9%), 96 (34.5%), and 64 (23%), respectively. As for the intraocular lenses, 175 (62.9%) surgeons preferred non-foldable and non-premium while 65 (23.4%) used multifocal. Viscoimplantation was preferred by 256 (92.1%) surgeons. Only 13 (4.7%) surgeons sutured the tunnel at the end while a subconjunctival antibiotic-steroid injection was used by 166 (59.7%) surgeons. Conclusion: Studying the variability in MSICS can help to carve future MSICS training programs and help novice surgeons to better perform the surgery.