Ophthalmology residency training programs have changed over the past two decades in the way that cataract surgery is taught. Twenty years ago we required our residents to perform at least a handful of manual extraction extra-capsular cataract extractions (ECCE) before beginning to learn phacoemulsification. We now start all residents directly with learning phaco and only later in their training do we introduce manual cataract extraction techniques for a handful of cases. We have since abandoned the older techniques of ECCE where corneo-scleral scissors were used to enlarge the incision, and instead, we have adopted the MSICS technique popular in places like India. MSICS is manual small-incision cataract surgery and the key to the procedure is the incision. It’s not a “small incision” like a sub-3 mm phaco incision, but it is constructed in such a manner that it seals very well with few, if any, sutures. The incision is trapezoidal in shape with the internal opening wider than the external one. The tunnel length is about 2 mm centrally and more peripherally. It is important for all cataract surgeons to learn how to perform MSICS. Trust me!
click to watch a talented young surgeon performs MSICS surgery to learn the pearls: