3057: MSICS requires a larger capsulorhexis
A standard 4.5 to 5.0 mm capsulorhexis is good for overlap of the IOL optic if we are performing phacoemulsification, but Manual Shelved Incision Cataract Surgery (MSICS) demands a significantly larger opening, typically 5.5 to 6.0 mm, to allow safe, whole-nucleus prolapse into the anterior chamber particularly with a dense cataract. Attempting MSICS with a small “baby rhexis” creates resistance during hydrodissection and prolapse, placing excessive stress on the zonules and increasing the risk of an extension run-out, equatorial tear, or zonular dialysis. To avoid trapped nuclear bulk, surgeons performing MSICS must adjust their spatial planning during the continuous curvilinear capsulorhexis (CCC) or enlarge a small rhexis with secondary relaxing tears before attempting nucleus delivery. Watch the video to analyze how a restrictive capsulorhexis complicates manual nucleus delivery and see the adjustments needed to safely prolapse the nucleus. What sizing target do you aim for when tearing a capsulorhexis specifically for MSICS compared to standard phaco? Please comment your thoughts below.
