Side port incision in manual small-incision cataract surgery – A teaching video for postgraduates

Abstract

Background: 

Manual Small Incision Cataract Surgery (MSICS) is the basic of cataract surgery with a short learning curve, less time-consuming, and can be performed in high-volume setups at low cost. Hence, it is imperative for every surgeon to know in detail the perfect way of wound construction and nucleus delivery methods.

Purpose: 

A teaching video prepared for the postgraduates to understand the importance of creating a proper side port wound construction in MSICS.

Synopsis: 

In MSICS, the side port is made for the intraocular manipulation, to fill the anterior chamber (AC) with viscoelastic and Balanced salt solutions, for easier rhexis in fluid tight maintained AC, for easy aspiration of cortex with deep AC, for cutting the extended rhexis margin with the vannas and for dialling the IOL into the bag complex (Video clip 1). In this video, a limbal stab incision for the side port is created with the 15 degree side port blade made of polycarbonate handle with maximum width of a 20G needle (1.5mm) made parallel to the iris plane of 1.5mm and the 90-110 degree distance from the superior main scleral incision to avoid astigmatic change in axis and power (Video clip 2). It is constructed with the pushing force applied along the cutting edge of the blade through the cornea to create an internal and external ostium, 0.5mm to 1mm thickness into the corneal stroma. The incision produced this way is considered astigmatically neutral (Video clip 3&4). Apart from the astigmatism, the side port is very important to avoid intra and postoperative wound leakage, iris prolapse, and DM detachment. The wound leakage favours bacterial contamination and endophthalmitis (Video clip 5). Ensure good quality of blade while entering the AC (Video clip 6). Hence, albeit small, the side port incision is as important as the main incision.

Highlights: 

The video explains the importance of creating a proper sideport, the benefits and the complications involved were clearly explained. Video link:https://youtu.be/nljn8c6XaHY

Keywords: MSICS, Side port construction, DM detachment