MSICS in Pseudo-Exfoliation

It is important to learn how to perform MSICS: manual small incision cataract surgery. This is a more evolved and refined way of performing manual extra-capsular cataract extraction (ECCE). The incision is much better because it is shelved with a good tunnel length and a trapezoidal configuration. The old ECCE incisions were made right at the limbus with corneo-scleral scissors and they sealed poorly and require many stitches. I have refined my way of performing MSICS by watching surgeons from India who have truly mastered this technique.

This patient was seen in our clinic and was noted to have bilateral cataracts and pseudo-exfoliation syndrome in both eyes. Of note, the left eye has a large gap between the iris and the lens which indicates severe zonular laxity and loss. The patient has Counting Fingers vision at 1 foot in both eyes. We opted to do surgery on the right eye first because of the better visual prognosis and stronger zonular support. The left eye cataract surgery will require some sort of IOL fixation to be performed.

Closer examination of the right eye shows extensive PXF material on the lens capsule, particularly at the pupil margin, and a dense nuclear cataract.

When we stain the anterior lens capsule with trypan blue dye we can see the PXF fibrillar material even better, including the characteristic zone of clearing from movement of the pupil margin across the anterior lens capsule.

The surgery is being performed by an ophthalmology resident who has performed about 40 prior cataract surgeries. The case goes beautifully and the patient was very happy with good vision on post-op day 1. You MUST learn to perform MSICS during your residency training!

Click below to learn how to perform MSICS in PXF:

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