More than 20 years ago when I was a resident ophthalmologist at the UCLA Jules Stein Eye Institute, we performed about a dozen manual ECCE procedures (extra-capsular cataract extraction) prior to beginning phacoemulsification. This was the older style of ECCE where corneo-scleral scissors were used to create the would and it would require many sutures for good closure. A better technique is the SICS (small incision cataract surgery), also called MSICS (manual small incision cataract surgery), because the technique is more refined with a better incision and better outcomes.
This video features surgical video from me performing SICS in our Beverly Hills surgery center. This patient had a very, very dense cataract and a relatively weak corneal endothelium. He was very myopic and his IOL power was not available with toric correction for his 2 diopters of with-the-rule astigmatism. SICS was the perfect choice since it allowed us to remove this ultra dense nucleus without an ultrasonic energy, thereby protecting his delicate cornea, and it even gave the benefit of helping to address his corneal astigmatism. So, yes, even in Beverly Hills, California, a good cataract surgeon must be able to perform SICS if needed.
The Indian surgeons have really pioneered the advancements in SICS surgery and they are teaching the world these techniques. My guest surgeon is Pradip Mohanta MD who shows us his technique for performing SICS / ECCE and he places just two sutures to close the incision. He also shows us the beautiful result on post-op day one.
click below to learn the technique of SICS / ECCE because you will absolutely need it: