3049: tough MSICS case with complications
In Manual Shelved Incision Cataract Surgery (MSICS), precise wound architecture is the absolute linchpin of success—it is the single design element that elevates MSICS far beyond traditional manual ECCE performed with corneo-scleral scissors. When an incision is constructed with improper depth, length, or internal shelving, fluidics collapse and intraoperative control is rapidly lost. In this instructive case, a suboptimal incision initiates a severe cascade of intraoperative complications, starting with recurrent iris prolapse, micro-hyphema and intraocular bleeding, and ultimately culminating in compromised capsular support and loss of the capsular bag. Maintaining a uniform, self-sealing sclerocorneal tunnel with an adequate internal flap valve is essential to cushion fluidic surges, maintain anterior chamber depth, and prevent catastrophic tissue trauma during nuclear delivery. Watch the video to analyze where the wound geometry failed and review the critical bailouts needed to manage these compounding complications. What helpful and constructive advice do you have for this young resident in training? Please comment your thoughts below.
