Cataract (मोतियाबिंद) is one of the very common ocular abnormalities, where the natural lens of the eye becomes cloudy and causes blurring/dimming of vision. SICS (Small Incision Cataract Surgery) or ‘छोटे चीरे से मोतियाबिंद ऑपरेशन’ is one of the surgical techniques for cataract extraction. This method has many advantages, especially in resource-limited settings or where advanced Phacoemulsification may not be necessarily ideal. Further below, we will elaborate on how SICS works, what benefits or limitations it has, the collection process, recovery, and who might be acquainted with it.
What is SICS?
Small Incision Cataract Surgery” is a manual cataract surgical procedure wherein the surgeon makes a 6-7mm incision (tunnel) in the sclerocorneal region to access and remove the cloudy lens and then implant an artificial intraocular lens (IOL). The incision is larger than that of Phacoemulsification but smaller and much better controlled than that of older extra-capsular techniques.
In SICS, the nucleus (the hard core of the lens) is usually expressed manually, often with the help of hydrostatic pressure or viscoelastic fluid, and not by ultrasonic energy. The foldable or rigid IOL is positioned after lens material removal.
Why Go in for SICS? The Key Advantages
SICS enjoys some practical and clinical benefits, especially in certain contexts:-
- Cost-effective: Less dependency on expensive machines and fewer expensive instruments may make SICS affordable.
- Reliability in dense cataracts:Phacoemulsification may not work well in very dense or advanced cataracts, while many circumstances have demonstrated greater success with SICS over harder nuclei.
- Reduced dependence on electricity or high technology: Very beneficial in locations where electrical supply is poor, with some intermittent power, or where resources are scarce, SICS stands well.
- Good visual outcomes: Those performed correctly often achieve excellent postoperative vision.
- Possibility of suture less closure:The incision is constructed such that it self-seals, thereby reducing the need for stitches but sometimes sutures may be needed.
- Fast & Reproducible: SICS-qualified surgeons can perform the operation rather quickly, thus enhancing throughput in busy centers.
Limitations & Trade-offs
Yet, though SICS is a strong option, some trade-offs accompany it:-
- Larger incision size than Phaco: The tunnel in SICS is larger than that in phaco, and therefore, it may produce slightly more induced astigmatism.
- Manual manipulation risks:Because the lens is manually expressed, there exists a unique risk of damaging adjacent structures if not done carefully.
- Healing and visual recovery: The healing period may be modestly longer than that of small-incision Phaco procedures.
- Skill dependency: Highly dependent on the experience of the surgeon relative to manual techniques.
Surgical Process: Step by Step
This is a typical outline of how SICS carries on:-
- Preop evaluation – Be as complete as possible in eye examination, including corneal status, retina, intraocular pressure, axial length, and biometry.
- Anesthesia and prep – Local usually topical anaesthesia or peri bulbar block. Sterilizing the eye and letting in dilating drops.
- Creating Incision and Tunnel – A small but well-designed incision is made, usually as a scleral-corneal tunnel, to allow access to the lens without causing undue stress to the eye.
- Capsulorhexis / Open Lens Capsule– The anterior capsule is held open for instrument access to lens material (Capsulorhexis).
- Nucleus Expression / Removal – Delicately brought out through the tunnel using hydrostatic forces, viscoelastic fluid injection, or manual vectis/forceps while taking care to protect the corneal endothelium.
- Cortical Cleanup – Now that the core of the lens, i.e., the central hard lens core, has been removed, it remains to remove the softer material outside (cortical), which should be done using a cannula.
- Intraocular Lens Implantation – Insert and appropriately position a suitable artificial intraocular lens (IOL) in the capsular bag or elsewhere.
- Incision Closure – Hydrate the tunnel or construct it so that it seals on its own. Additional suture less wound closure techniques are also used, depending on the surgeon’s judgment.
- Post-operative medication – Antibiotic and anti-inflammatory drops will be administered to the patient to avoid infection and control inflammation.
Recovery & Aftercare
- Immediate post-op – The patient may be kept in the recovery area for some time. In this period, avoid rubbing or pressing the eye.
- Medication regimen– Eye drops (antibiotic, steroid, possibly anti-glaucoma drops) need to be given, gradually tapering them down as healing goes on.
- Regular check-ups – Regular visits for review of eye healing, IOL placement stability, and early detection of possible complications.
- Activity Restrictions – Do not lift heavy things, bend over, or do strenuous activities during the initial phases. Avoid water, as in swimming and splashing, until approved.
- Visual improvement timeline – Patients will notice improvement within days, but it may take a couple of weeks for full stabilization.
Who Makes a Good Candidate for SICS?
SICS is often preferred in the following situations:-
- Patients with dense, advanced, or mature cataracts that are harder to emulsify.
- Settings where cost or infrastructure limits the availability of high-end Phaco machines.
- Resource-limited or rural surgical centers.
- Eyes that have weaker corneal parameters, wherein lesser energy is advantageous.
- Surgeons experienced in the manual technique of cataract extraction.
Complex cases of anterior segment anatomy or weak capsular support, or those with concurrent comorbid corneal conditions, would need different approaches or advanced new surgical methods.
Their Possible Complications & Precautions
Some complications still may arise with SICS, though in general, it remains safer:-
- Wound leakage or failure of the self-sealing incision
- Induced astigmatism due to incision architecture
- Damage to corneal endothelial cells
- Capsular tears or posterior capsule rupture
- Dislocation or Decentration of IOL
- Infection or endophthalmitis
- Increased intraocular pressure
Thus, care in the selection of the patient, a high degree of diligence in the surgical technique, and the operation of a stringent aseptic regimen should be followed to minimize these complications.
A Comparison between SICS and Phaco: A Brief Note
- Incision size – Phaco uses a smaller incision (micro incisions) compared to SICS.
- Energy use –Phaco uses ultrasonic energy to break up the lens, while SICS involves manual expression.
- Recovery and astigmatism –Phaco tends to induce less astigmatism and faster visual recovery in ideal cases.
- Cost & infrastructure – Phaco machines and consumables are more expensive; SICS can be more accessible.
- Suitability with dense cataracts –SICS often has an advantage with very dense or hard cataracts.
Why SICS is popular eye treatment?
In many parts of the world, particularly in developing regions, SICS still is the backbone of cataract blindness control programs. The low cost, reproducible nature, and satisfactory visual outcome of SICS rightfully place it among the best candidates serving a wide patient population.
Surgeons who are capable of SICS know they will restore sight for many needy patients who otherwise would not have access to such high-end technology.
Conclusion
Small Incision Cataract Surgery (SICS) is a well-tested surgical procedure to treat cataracts. It is a method chosen on the basis of cost, efficacy, and adaptability. While it may not shine in every single case, it remains a mighty warrior where Phacoemulsification is not available or in eyes with dense cataracts.SICS’ success is highly reliant on the surgical aptitude, meticulous planning, and aftercare provided by the surgeon. For the rightly selected candidates, it can grant them clarity of vision, lesser dependence on spectacles, and, thus, a significantly better quality of life.
