Ruit Sanduk, Gurung Reeta, Vyas Shyam
Tilganga Institute of Ophthalmology, Kathamandu, Nepal.
Curr Opin Ophthalmol. 2018 Jan;29(1):105-109. doi: 10.1097/ICU.0000000000000442.
Manual small incision cataract surgery (MSICS) has recently gone through much refinement and fine tuning. It is often taken as an alternate option for phacoemulsification, especially in developing country. This review will present some insight on its applications especially for developed nations. The role of MSCIS in tackling complex cataracts with stony hard nucleus is fairly established. The role of training residents with MSCIS has certain advantages though debatable.
MSCIS is much faster and cost-effective surgical technique often possible in suboptimal condition and avoids the capital and maintenance cost of phacoemulsification. The visual outcome and postoperative complications in both phacoemulsification and MSCIS are comparable. Slightly greater astigmatism in MSICS can be lessened with a slight modification of surgical technique. The successful application of MSCIS in large public health programmes has successfully helped to increase the cataract surgical rate and quality. It is the technique of choice for blindness control programme in developing country.
MSICS is established as safe and cost-effective procedure in developing country with results as good as phaoemulsification. Although it may not be the best option for developed nations, it is a valuable skill especially for surgical conversion and to deal with complex and advance cataract cases. Hence, it should be a part of resident training programme in developed world and it should be in the armamentarium of every cataract surgeon.
手动小切口白内障手术(MSICS)最近经过了大量改进和微调。它常被视为超声乳化术的替代选择,尤其是在发展中国家。本综述将介绍其应用方面的一些见解,特别是对发达国家而言。MSICS在处理硬核复杂白内障方面的作用已相当明确。用MSICS培训住院医师有一定优势,尽管存在争议。
MSICS是一种速度更快且性价比更高的手术技术,在欠佳条件下往往可行,还能避免超声乳化术的设备购置和维护成本。超声乳化术和MSICS的视觉效果及术后并发症相当。通过对手术技术稍作改进,可减轻MSICS中稍大的散光。MSICS在大型公共卫生项目中的成功应用,成功提高了白内障手术率和质量。它是发展中国家防盲项目的首选技术。
在发展中国家,MSICS已被确立为一种安全且性价比高的手术,效果与超声乳化术一样好。尽管它可能不是发达国家的最佳选择,但它是一项宝贵技能,尤其适用于手术转换以及处理复杂和晚期白内障病例。因此,它应成为发达国家住院医师培训项目的一部分,并且应是每位白内障外科医生的技术储备。