In cases of severe phacodonesis, where zonular support is nearly non-existent, a standard extracapsular approach often risks complete lens dislocation. Intracapsular Manual Small-Incision Cataract Surgery (MSICS) becomes the preferred salvage maneuver. The goal is to deliver the entire lens-capsule complex through a superior sclerocorneal tunnel. After a generous peritomy, an 8mm frown-shaped incision is crafted to allow the bulky, intact lens to exit without rupturing the fragile capsule or inducing vitreous loss. Once the cataract is removed, a vitrectomy is often necessary to clear the anterior chamber. Since no capsular bag remains, a scleral-fixated IOL is indicated. This dual-stage approach, total extraction followed by scleral fixated IOL, restores visual stability and prevents the long-term complications of a migrating lens.
