1733: Can you do MSICS without a peritomy?

Today I have more questions than answers. I enjoy performing the MSICS technique and even in our Beverly Hills surgical center, I employ this technique a few times per year. When I was teaching the UCLA ophthalmology residents in the operating room, I taught them this technique as well. Certainly, it is a very useful technique and in many cases it can be better and safer than performing phacoemulsification. Our guest surgeon today has expert hands and elects to perform MSICS without a peritomy and the result is very nice. Among our CataractCoach fans, there are many surgeons who perform MSICS dozens of times per week, with a depth of experience that is rare to find in my community. For these experts, my question to you is: Should you perform MSICS without a peritomy? Your comments are encouraged.

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  1. I do not prefer MSICS without peritomy. I cover the scleral wound by conjuctival flap and secure it with bipolar cautery or 10-0 nylon suture. I believe MSICS wound without conjunctival peritomy is less secure.

  2. Would like to have seen some posterior lip of the wound pressure in the OR to see if there was any leakage, and at least some hydration of the roof and even the edges (sorry, Uday) of the main incision.

  3. Thank you for sharing Dr. Devgan. Overall, a nicely done MSICS. Certain points to note:-1. A Fornix based conjunctival flap would ensure more safety. 2. The tunnel may be initiated 1.5mm posteriorly than shown; more secure closure. 3. A smaller tunnel length with back pockets would ensure more space for the nucleus to be delivered and overall less SIA. Good and fast surgery by the doctor from Bangladesh.

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