الفهرس 
ANATOMY OF THE CORNEAOnly 14 pages are availabe for public view
 |  | from | 171 |  |  |
| | | from | 171 | | |
Abstract
Early visual rehabilitation after cataract surgery was one of major advantages offered by phacoemulsification surgery, this was mainly attributed to the small incision size used. But, phacoemulsification may not be an affordable technique in the developing countries due to its high cost which is one of the most important barriers to cataract surgery.
Manual SICS with its sutureless relatively smaller incision, has similar advantages to phacoemulsification and is affordable. It has been evolved as an effective alternative to phacoemulsification in the present times because it combines both the sutureless advantages of phacoemulsification with minimum investment. It is now gaining popularity as quick, relatively inexpensive techniques for large-scale cataract management in the developing world.
In our hands, and using the techniques and instrumentations described in this thesis, we came to the following conclusions:
We found that both techniques give excellent visual results with 86% of both the manual SICS group and the phacoemulsification group attained BCVA of better than or equal 6/9 at the three-month follow-up visit. Also we found that the mean surgically induced astigmatism was 1.720±0.660 diopters in the SICS group and 1.220±0.480 in phacoemulsification group at 3 months with the difference between both groups less man one diopters. The postoperative changes in the CCT in both groups was statistically non significant after 3 months while it was statistically highly significant after 1 day, 1week and 1 month postoperative being higher in the phacoemulsification group.
Both techniques were associated with a usual rate of AC reaction and postoperative IOP elevation in most of cases but with moderate to severe reaction may be seen in few cases in the phacoemulsification group especially those with very hard cataracts.
We found an equal incidence of PCO in both groups but the duration of the study was not enough to manage such complication and include them in the results.
There are many surgeons nowadays especially in the developing countries who prefer manual SICS, while others perceive phacoemulsification as the only way. The question is that, is there a reason for phaco surgeons to learn MSICS too? 100% phacoemulsification, like 100% anything else, is not possible. Even the most experienced phaco surgeons need to bailout sometimes, even if it is only due to machine failure. The published literature from India documents this occurrence as 3.7%, about one in 25, phacoemulsification converted to an unplanned standard ECCE with results worse than that of planned ECCE. Conversion to MSICS usually utilizes the same wound and provides better outcomes. Therefore, MSICS is really not so much an alternative but can be an additional technique.
Also transition to phacoemulsification is easier if one has mastered manual SICS, as he will be familiar with steps such as scleral pocket incision, capsulorhexis and hydro procedures. Familiarity with these steps helps to reduce the incidence of complications while learning phaco.
The message from our study is that it is very important to master manual SICS either for beginners to be like a step for learning phacoemulsification later on or even for expert surgeons who already master phaco- emulsification to be like an extra weapon if they need to convert during surgery to get much better results than extra-capsular cataract extraction or to be their first choice in cases with very hard nuclei.