Sutureless cataract surgery with a scleral tunnel incision was first introduced in the late 1980s and became a standard technique [ 1 - 3 ]. My question is this: should the incision be sutured closed or left unsutured? Scleral cauterisation before tunnel. & Manual small incision cataract surgery through 5.5 to 6.5 mm incision with sclerocorneal tunnel with PMMA PCIOL implantation. One side port is made 90 degrees apart on either side of A self-sealing corneo-scleral tunnel is created using a 30-degree straight knife ( b ), crescent knife ( c ), and a slit knife ( d) at the 12 o'clock position. The surgically induced astigmatism (SIA) depends on . Small incision cataract surgery (SICS) through a sclerocorneal tunnel has come as a boon as it has been demonstrated that smaller the incision, lesser the number of sutures and valvular construction of wound would induce minimal astigmatism.2 The best corrected tunnel was created with a straight incision, starting 2 mm pos- visual acuity was 6/18 or better in 96.2% of eyes at 6 weeks and terior to the limbus. the need for a large incision with the Verisyse lens may have caused the problem in this case. In our novel technique, we fashioned a triplanar self-sealing 6.5 mm sclerocorneal tunnel to facilitate easy explantation of the rigid iris-claw phakic IOL. ficult to create a sclerocorneal tunnel incision in the presence of conjunctival scarring. Small incision cataract surgery (SICS) through a sclerocorneal tunnel has come as a boon as it has been demonstrated that smaller the incision, lesser the number of sutures and valvular construction of wound would induce minimal astigmatism. A 2.0 mm bent transconjunctival single-plane sclerocorneal incision was made with a 2.0 mm slit knife (Alcon Laboratories, Inc.). 2 Manual small incision cataract surgery (MSICS) has emerged as a popular technique and it has been . surgery (SICS) through a sclerocorneal tunnel has come as a boon as it has been demonstrated that smaller the incision, lesser the number of sutures and valvular construction of wound would induce minimal astigmatism 2. The Masket Anti-Dysphotopic IOL is captured in the capsular bag. There are two aspects of the incision for SICS which we must consider. The tunnel should be wider in the cornea than at its scleral opening patients with age-related cataracts underwent small incision suture less cataract surgery without phacoemulsification. One sideport is made 90º on either side of the scleral tunnel with a 15º knife, temporally in a right eye and nasally in a left eye. Wounds are less secure than Sclerocorneal tunnel incision. Understands that tunnel depth is A Longitudinal Study to evaluate post-operative astigmatic effect of the steepest meridian sclerocorneal tunnel incision on eye undergoing cataract surgery in KLES Hospital, Belagavi. In the case of a foldable IOL, a 2.5-mm clear corneal. One sideport is made 90º on either side of the scleral tunnel with a 15º knife, temporally in a right eye and nasally in a left eye. Superior sclerocorneal tunnel incision with adjustable tension triple-X suture closure. Surgically induced astigmatism is more compared to scleral incision. Only a correct sclerocorneal tunnel incision, at least 1-2 mm into the clear cornea, leads to a self-sealing wound. METHODS: 96 eyes of 88 patients with age-related cataracts underwent small incision suture less cataract surgery without phacoemulsification. The sclerocorneal tunnel incision is thus shaped like an isosceles trapezoid. Surgery involved a 3.2 mm superior clear corneal tunnel incision, injection of viscoelastic material into the anterior chamber, capsulorhexis of 5 mm, hydrodissection, in the bag phacoemulsification using phaco-chop technique, cortex aspiration, additional injection of viscoelastic material and insertion of foldable hydrophobic intraocular lens . 6 mm single piece PMMA lens was implanted in the capsular bag. Capsulorrhexis. sclerocorneal tunnel incision covered by conjunctiva. Reports have shown that the unsutured incision can be opened during trauma. The tunnel was dissected (Fig.2) with the help of sharp edge tunnel (crescent) blade angled bevel up no 582620/582623.The incision depth is usually up to 2/3rd thickness of sclera. As a part of treatment, the corneal filaments were removed and patient was advised post cataract steroid tapering, 1% carboxy methyl cellulose eye drops one hourly and four times instillation of 10% N- Acetyl cysteine eye drops. There are two methods of converting from phacoemulsification to MSICS (Fig. 6 mm single piece PMMA lens was implanted in the capsular bag. In Hosanna and other low-resource settings, however, cataracts are often removed with manual small-incision cataract surgery (MSICS) instead of phacoemulsification. Tunnel length was decided by the surgeon preoperatively or intraoperatively for each case at his discretion. 5 Other reports have shown that when the incision. One is the self sealing nature of the wound, and the other is the 15 Bard Parker blade (Figure 1E). Side Port Incision: A paracentesis knife or 26 gauze needle is used to make a side port entry at the limbus Sclerocorneal Tunnel Inappropriate incision depth, location, and size, hesitant dissection. The tunnel should be of one third to half of the width of the thickness of sclera extending 1-1.5 . 2006 Oct-Dec; 18(4):53-7. All other surgical procedures and postoperative medication were standardized. A side-port incision was created to facilitate in 95.9% at 1 year. Details of the temporal main wound construction. An 8 mm long, straight, partial thickness scleral incision with its center 2 mm from the limbus was made with a 2.5 mm crescent knife (Alcon Surgicals, Fort Worth, TX, USA). Surgical technique of superior conjunctival sclerocorneal incision. I would create a 10-mm sclerocorneal tunnel incision. All eyes were operated by the phaco-sandwich technique through sclerocorneal tunnel with 6 mm frown-shaped external scleral incision. Intratunnel phacofracture MSICS can be performed through an incision of 4 mm to 8mm at a superior, superonasal, superotemporal, or temporal site. I would pursue the simplest solution for this extremely challenging case. Scleral cauterization before tunnel construction reduces the risk of pre- and postoperative hyphema. The Sclerocorneal Tunnel Construction Course (STCC) is the first in a series of HelpMeSee MSICS courses that focuses on this important segment of the Manual Small Incision Cataract Surgery (MSICS) procedure. From the external scleral incision, sclerocorneal tunnel dissection is effected from then on. Cataract surgeries by phaco- sandwich technique through sclerocorneal tunnel, a cohort study in Oman. Iris prolapse may occur One of the following correct: incision depth, location or size. with sclerocorneal tunnel incisions,1,2 the bulk of the recent literature suggests that post-cataract endophthalmi-tis is more likely with corneal incisions (Table 1).3-6 The . construction reduces the risk of pre- and postoperative hyphaema. given—for example, manual small incision cataract surgery (SICS), mini-nuc technique, manual phaco—for sutureless manual ECCE,5-9 a procedure in which the entire nucleus is removed through a sclerocorneal tunnel.However,these tech-niques have been superseded by phacoemulsification in most industrialised countries. Diathermy is used to blanch the scleral incision area A sclerocorneal tunnel is made and a tissue plane parallel to the ocular surface is dissected from the sclera through the limbus and 1-1.5 mm into clear cornea. small pupils. In peadiatric patients, anterior chamber is reformed with air at the end of the surgery. A conjunctival incision is created in the superior conjunctiva ( a ). I/A was done with simcoe canula and lens implanted either in the bag or in the sulcus. The technique of SICS is less expensive and less dependent on Figure 5. The tunnel was prepared parallel to the surface within the sclera with a 3.2-mm diamond keratome. incision with Foldable PCIOL implantation. If the initial wound was sclerocorneal, one could modify the same to convert it into an MSICS wound. It occurred to me to combine the two concepts in our setting, where a vast majority of footfalls is of the poorer sections of society. Sharp tunnel instruments (such as the crescent knife and keratome) should be used to construct the tunnel. A funnel-shaped sclerocorneal tunnel incision is created with a steel crescent knife. The anterior extent of the incision is always more than 2mm behind the limbus and two ends can be 4 to 5 mm behind the limbus. Bayramlar H, Cekiç O, Totan Y. Manual tunnel incision extracapsular cataract extraction using the sandwich technique. One side port is made 90 degrees apart on either side of the scleral tunnel with a 15 degree knife temporally in right eye and nasally in left eye. A blunt keratome could cause stripping of Descemet's membrane. The peripheral groove on the anterior edge of the optic captures the anterior capsule edge. The next step, creation of the sclerocorneal tunnel, is the most difficult part . Dr. Vivek M. Kothawade discusses staining corneal tissue with blood while constructing a sclerocorneal tunnel in manual small incision cataract surgery (MSICS). Added visibility makes it much easier and simpler to achieve good wound construction. Added visibility makes it much easier and simpler to achieve good wound construction. 4. MSICS carries the following advantages over ECCE and phacoemulsification (when the surgeon makes use of an ultrasonic device to break up the cloudy… Sharp tunnel instruments (such as the crescent knife and keratome) should be used to construct the . sclerocorneal tunnel is the procedure gives advantages of sutureless wound closure with less astigmatism at low cost. • Scleral cauterisation before tunnel. 4 ). the main 3-plane incision was performed superior-ly. Clear corneal incision Patient responded to the treatment with Statistical biplanar sclerocorneal tunnel is constructed, beginning around 1.5-2.0 mm posterior to the limbus and with a depth of around 70% of the scleral thickness, either superior or temporal without entering the anterior chamber. 19.3 ). One side port is made 90 degrees apart on either side of the scleral tunnel with a 15 degree knife temporally in right eye and nasally in left eye. Sclerocorneal tunnel. incision and tunnel construction. ISSN: 2573-9573 Abstract Objective: Aim of the study is to Compare the astigmatism induced by a reduced temporal sclerocorneal tunnel incision It has advantage of using requiring much less expenditure of energy. A 3.0 mm sclerocorneal tunnel is fashioned and extended into clear cornea for 1.5 mm. Step No. In ad-dition, visualization may be hindered by a poor red reflex caused by a dense Tunnel was constructed as per our modified technique described above. With a 2.8 mm keratome, the anterior chamber was entered 1.5 mm into the clear cornea. Using the crescent knife, a 4 mm long sclerocorneal tunnel was dissected from the scleral incision, extending approximately 2 mm into clear cornea (Figure 1(b)). Cortical hydrodissection was done and nucleus was emulsified using divide and conquer technique. There was no need to further enlarge the incision. (11) AIMS AND OBJECTIVES 1. Conclusion: A proper selection of an appropriate incision site and type allows to correct the preexisting astigmatism or to keep a spherical refraction after an implantation of a 6-mm-rigid phakic iris-claw IOL. Constructing the tunnel. A sclerocorneal tunnel was prepared 1.5 mm in the cornea. "The 'frown' incision has proved to cause the least surgically induced astigmatism," Dr. Hennig explained. Only a correct sclerocorneal tunnel incision, at least 1 to 2 mm into the clear cornea, leads to a self-sealing wound. After a 1.5-mm bevel-down corneal course, the anterior chamber was entered, and the two-step sclerocorneal tunnel incision was completed. Intratunnel phacofracture is a nucleus management technique of the manual small incision cataract surgery (MSICS), in which the lens nucleus is broken inside a sclerocorneal tunnel and removed. Recently, there has . It is predominantly used in developing countries due to low costs. A 2.3 to 2.5 mm long clear corneal tunnel was prepared using a diamond blade scalpel. shaped incision with a 25-gauge knife, and a scleral tun-nel was made parallel to the limbus at the branch point of the T-shaped incision. For all patients, macular OCT was performed during preoperative period & post-op 1 st day,7th day, 1 month, 3rd thmonth & 6 month. A 6-mm scleral frown incision, 1.5 mm from the limbus, is made with a No. There are several external scleral incisions including With a bevel-up angled 2.8 mm tunnel blade/crescent smiling or anti-frown, frown, inverted V-shaped, knife at a depth of 0.3 mm, a scleral tunnel is dissected scleral flaps and straight. Judge the depth of half-thickness sclerocorneal tunnel incisions by observing how clearly you can see the crescent knife during the incision (Figure (Figure4). A 3.0-mm sclerocorneal tunnel incision was created at the 10 to 12 o'clock position, through which a 3-piece IOL (NX-70 Santen Pharmaceuti-cal Co., Osaka, Japan) was implanted with an injector. After cauterisation of blood vessels a sclerocorneal tunnel, 1.5 mm behind the limbus, with a 2.5-mm anterior chamber opening was performed. The sclerocorneal tunnel incision has been used in millions of cataract extractions via phacoemulsification. With a half-thickness sclerocorneal tunnel incision, the direction of the crescent knife should always be parallel to the sclerocorneal plane. Two side pockets are made on each end of the tunnel incision to create an internal incision length of 10.0 mm. With a 2.8 mm keratome, the anterior chamber is entered 1.5 mm into the clear cornea. incision type on the incidence of endophthalmitis after cataract surgery. J Ayub Med Coll Abbottabad. 6.5 mm sclerocorneal tunnel to facilitate easy explantation of the rigid iris-claw phakic IOL. If the original incision is clear corneal, a sclerocorneal tunnel is made 90° away (superior if a temporal clear corneal incision has been made, and vice versa). A funnel shaped sclerocorneal tunnel incision is created with a steel crescent knife. To compare between the surgically induced astigmatism (SIA) in small incision cataract surgery (SICS) by superior 2.50, $0.05). The large incision size was used to deliver the nucleus with manual small incision cataract surgery technique obviating the need of phacoemulsification. After injecting diluted triamcinolone and removing any visible vitreous strands, I would inject a dispersive OVD behind and in front of the black cataract. A clear corneal incision is recommended in such eyes. In the clear corneal incision group, a 300 μm deep anterior limbal incision was made parallel to the limbus. The course covers the surgical tasks involved in constructing a self-sealing MSICS tunnel. Able to dissect forward but not able to perceive depth Two of the following are correct: incision depth, location or size. The sclerocorneal tunnel induced 0.75 D cyl, while the two-incisional techniques delivered nearly astigmatismus neutral results. The ultimate outcome and the ease of delivering the nucleus are dependent on wound architecture. All eyes were operated by the phaco-sandwich technique through sclerocorneal tunnel with 6 mm frown-shaped external scleral incision. Three paracentesis sites were created with a 15° slit knife at the 3-, 6-, and 12-o'clock positions (for the right eye). After making an incision, a proper sclerocorneal tunnel is made with the help of crescent blade and then an entry is made into the AC [Figs. removed with manual small-incision cataract surgery (MSICS) instead of phacoemulsification. Several variables are there in the construction of wound of cataract surgery like location, direction, width, depth and shape. Manual small incision cataract surgery (MSICS) is a technique of extracapsular cataract extraction (ECCE) in which cataract extraction and intraocular lens (IOL) implantation are performed through a suture less, self-sealing valvular sclerocorneal tunnel incision. Schematic drawing of the Anti-Dysphotopic IOL. This involved sclerocorneal tunnel, capsulotomy and hydrodissection. Sclera-corneal Tunnel A 6 mm scleral frown incision, 1.5 mm from the limbus is made with a 15 number Bard Parker blade (Figure 5). A corneal side-port incision, for a second instrument, is created. Step No. 2015-2018: 47: Dr. Mohammada Salman Patel: Dr. A. L. Tenagi Using the crescent knife, a 4 mm long sclerocorneal tunnel was dissected from the scleral incision, extending approximately 2 mm into clear cornea (Figure 1(b)). The large incision size was used to deliver the nucleus with manual small incision cataract surgery technique obviating the need of phacoemulsification. Only a correct sclerocorneal tunnel incision, at least 1-2 mm into the clear cornea, leads to a self-sealing wound. • Sharp tunnel instruments (such as the crescent knife and keratome) should be Intratunnel phacofracture MSICS can be performed through an incision of 4 mm to 8mm at a superior, superonasal, superotemporal, or temporal site. 4. Figure 7. Intraocular pressure was measured preoperatively and 6 hours, 1, 2, and 3 days, and 5 months postoperatively. The incision was made with number 11 disposable surgical blade (costing Indian Rs. Construction of a small, self-sealing sclerocorneal tunnel for delivering the cataractous lens is the central principle in MSICS, and the procedure can be done with either a temporal or a superior incision, whichever is more convenient. The anterior chamber was then entered using a lancet. With a 2.8-mm keratome, the anterior chamber is entered 1.5 mm into the clear cornea with the help of a Nucleus extraction was done by phaco-sandwich method with the help of vectis and dialer. Sharp tunnel instruments (such as the crescent knife and keratome) should be used to construct the tunnel. The surgically induced astigmatism (SIA) depends on . Site of incision makes too much difference on post- operative astigmatism. Can J Ophthalmol 2000; 35:373-378 . Following sclerocorneal tunnel incision, capsulorhexis, hydro dissection, nucleus was delivered with the help of lens loop (microvectis). A newer site of incision, limbal incision will have a faster healing and it can resist deformation pressure than corneal incision. Small incision cataract surgery (SICS) through a sclerocorneal tunnel has come as a boon as it has been demonstrated that smaller the incision, lesser the number of sutures and valvular construction of wound would induce minimal astigmatism.2 In small incision cataract surgery (SICS) the most common incision taken is the superior one than temporal The anterior chamber was completely filled with air for 45-60 min, followed by a sufficient air-liquid exchange to pressurise the eye and to prevent pupillary block. A funnel-shaped sclerocorneal tunnel incision is created with a steel crescent knife. than a superior sclerocorneal phaco incision [1-2]. It is a triplanar self-sealing tunnel and does not require any suturing. A clear corneal tunnel incision was made in 53 eyes and a sclerocorneal incision with tunnel preparation in 55. The sclerocorneal tunnel was created with a frown incision centered at 9'O (right eye) or 3'O (left eye) clock position. MSICS is a modified extracapsular technique that involves creating a self-sealing, 7- to 8-mm sclerocorneal tunnel incision through which the nucleus is delivered whole. Ideal Tunnel • Location :1.5-2 mm from anterior border of limbus • Depth : between 1/2 and 3/4 thickness of the sclera • 1.5 mm internal corneal lip • The wound construction in small incision cataract surgery in the form of a sclerocorneal tunnel should aim to achieve a self-sealed, astigmatically neutral wound. STCC will benefit those interested in . Then, the sclerocorneal tunnel incision was completely closed with interrupted 10-0 nylon sutures. The mean duration of surgery was 4 minutes. The scleral incision is 8 mm in linear length, the funnel-shaped sclerocorneal tunnel is 4 mm in length (2 mm in the sclera and 2 mm in the clear cornea), the internal corneal wound opening is about 9 to 10 mm in length, and 2 side pockets are constructed for large nuclei. Dr. Vivek M. Kothawade discusses staining corneal tissue with blood while constructing a sclerocorneal tunnel in manual small incision cataract surgery (MSICS). The scleral incision consists of three parts: the scleral groove or external incision, dissection of the sclerocorneal pocket tunnel, and entry into the anterior chamber or the internal incision. Intratunnel phacofracture is a nucleus management technique of the manual small incision cataract surgery (MSICS), in which the lens nucleus is broken inside a sclerocorneal tunnel and removed. Postoperative BAB disruption was measured with a laser flare-cell meter (Kowa FC 1000) in an undilated pupil on 1, 3, 7, 14, 28, 60, and 90 days . Figure 6. Small incision cataract surgery (SICS) through a sclerocorneal tunnel has come as a boon as it has been demonstrated that smaller the incision valvular construction of wound would induce minimal astigmatism. The incision was centered on the steepest merid-ian (usually the vertical) and was done in three dis-tinctive steps: (1) vertical semi-scleral incision 2 mm behind the limbus with a 15-degree blade; (2) scleral tunnel to the clear cornea with a crescent knife (ap- Therefore, the sclerocorneal tunnel incision has the advantage of better anterior chamber approach and less incision induced astigmatism. The Blumenthal;s 'Mininuc' technique enables nuclear expression through a 5-6.5-mm sclerocorneal tunnel incision using a Sheet's lens glide and anterior chamber maintainer (ACM). The complication might have been avoided, however, if the surgeon had used a frown-shaped sclerocorneal tunnel incision, as originally described by Singer.1 I routinely use this method when implanti- The scleral tunnel has six aspects: size (i.e., the length of the tunnel), shape (style), location, depth, width, and entry into the anterior chamber. MSICS is a modified extracapsular technique that involves creating a self-sealing, 7- to 8-mm sclerocorneal tunnel incision through which the nucleus is delivered whole. In the early 1990s, the clear corneal incision (CCI) was developed and its use spread rapidly worldwide [ 4 - 6 ]. As discussed above, capsulorrhexis may be difficult due to a lack of posterior support. construction reduces the risk of pre- and postoperative hyphaema. Posterior chamber intraocular lens implantation was done according to biometric findings. further intraocular manipulation. The instruments required for this approach are inexpensive. A funnel shaped sclerocorneal tunnel incision is created with a steel crescent knife. 6. The scleral. Constructing the tunnel • Only a correct sclerocorneal tunnel incision, at least 1 to 2 mm into the clear cornea, leads to a self-sealing wound. 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