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Indian J Ophthalmol. 2019 Jul;67(7):1073-1078. doi: 10.4103/ijo.IJO_1261_18.

Evaluation of complications and visual outcome in various nucleus delivery techniques of manual small incision cataract surgery.

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Department of Ophthalmology, Gandhi Medical College, Bhopal, India.
Department of Ophthalmology, Gandhi Medical College, Bhopal; Department of Ophthalmology, AIIMS, Bhopal, Madhya Pradesh, India.



To evaluate various methods of nucleus delivery in manual small incision cataract surgery, with reference to visual outcome, intraoperative, and postoperative complications.


In this prospective randomized interventional study, five groups of 40 cases each were constituted, with reference to nucleus delivery technique: (a) phacosandwich, (b) fishhook, (c) irrigating vectis, (d) viscoexpression, and (e) anterior chamber maintainer (ACM). Visual outcome, intraoperative, and postoperative complications were evaluated in detail. Follow-up was done on first and seventh postoperative days (PODs) and then at fourth and eighth postoperative weeks.


The most common intraoperative complication was intraoperative miosis, followed by intraoperative hyphema, seen more in phacosandwich and irrigating vectis groups. The most common postoperative complication was striate keratopathy followed by transient postoperative corneal edema and AC inflammatory response, seen more in phacosandwich and fishhook groups. With reference to visual acuity, on the first POD 95% cases of ACM group achieved visual acuity >+0.5 logMAR unit. The difference in the visual outcome among groups was statistically significant. On fourth and eighth postoperative weeks, best-corrected visual acuity among various groups was comparable.


ACM and viscoexpression are effective techniques for early visual rehabilitation. Fishhook has limited utility in softer nuclear grades and black cataracts. Phacosandwich is more suitable for nuclear sclerosis Grades 3-4. Irrigating vectis, viscoexpression, and ACM technique are effective techniques for all grades of nucleus Postoperative surgical-induced astigmatism was comparable in all techniques.


Manual SICS; anterior chamber maintainer; fishhook; irrigating vectis; phacosandwich; viscoexpresssion

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