Manual Small-Incision Cataract Surgery

  • Venkatesh Rengaraj
  • Steven S. Ma
  • David F. ChangEmail author


Cataract is the leading cause of avoidable blindness worldwide, accounting for nearly half (47.8 %) of all cases of blindness [1]. According to the World Health Organization (WHO), an estimated 20 million people worldwide are blind from bilateral cataracts [2]. While this poses one of the greatest public health challenges for developing countries, it poses a growing economic challenge for the well-developed country as well.


Cataract Surgery Posterior Capsule Opacification Uncorrected Visual Acuity Scleral Tunnel Cataract Surgeon 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.


  1. 1.
    Resnikoff S, Pascolini D, Etya’ale D, et al. Global data on visual impairment in the year 2002. Bull World Health Organ. 2004;82:844–51.PubMedCentralPubMedGoogle Scholar
  2. 2.
    Baltussen R, Sylla M, Mariotti SP. Cost-effectiveness analysis of cataract surgery: a global and regional analysis. Bull World Health Organ. 2004;82:338–45.PubMedCentralPubMedGoogle Scholar
  3. 3.
    Tabin G, Michael Chen M, Espandar L. Cataract surgery for the developing world. Curr Opin Ophthalmol. 2008;19:55–9.CrossRefPubMedGoogle Scholar
  4. 4.
    Thylefors B. A simplified methodology for the assessment of blindness and its main causes. World Health Stat Q. 1987;40:129–41.PubMedGoogle Scholar
  5. 5.
    Frick KD, Foster A. The magnitude and cost of global blindness: an increasing problem that can be alleviated. Am J Ophthalmol. 2003;135:471–6.CrossRefPubMedGoogle Scholar
  6. 6.
    Lam DS, Li EY, Chang DF, Zhang MZ, Zhan HK, Pang CP. Project vision: a new and sustainable model for eliminating cataract blindness in China. Clin Experiment Ophthalmol. 2009;37:427–30.CrossRefPubMedGoogle Scholar
  7. 7.
    Congdon N, Vingerling JR, Klein BE, West S, Friedman DS, Kempen J, O’Colmain B, Taylor HR. Eye Diseases Prevalence Research Group. Prevalence of cataract and pseudophakia/aphakia among adults in the United States. Arch Ophthalmol. 2004;122:487–94.CrossRefPubMedGoogle Scholar
  8. 8.
    Gollogly HE, Hodge DO, St Sauver JL, Erie JC. Increasing incidence of cataract surgery: population-based study. J Cataract Refract Surg. 2013;39:1383–9.PubMedCentralCrossRefPubMedGoogle Scholar
  9. 9.
    Bhagat N, Nissirios N, Potdevin L, Chung J, Lama P, Zarbin MA, Fechtner R, Guo S, Chu D, Langer P. Complications in resident-performed phacoemulsification cataract surgery at New Jersey Medical School. Br J Ophthalmol. 2007;91(10):1315–7.PubMedCentralCrossRefPubMedGoogle Scholar
  10. 10.
    Foster A. VISION 2020: the cataract challenge. Community Eye Health. 2000;13:17–9.Google Scholar
  11. 11.
    Zhang XJ, Jhanji V, Leung CK, Li EY, Liu Y, Zheng C, Musch DC, Chang DF, Liang YB, Lam DSC. Barriers for poor cataract surgery uptake among patients with operable cataract in a program of outreach screening and low cost surgery in rural China. Ophthalmic Epidemiol. 2014;21(3):153–60.CrossRefPubMedGoogle Scholar
  12. 12.
    Blumenthal M, Moisseiev J. Anterior chamber maintainer for extracapsular cataract extraction and intraocular lens implantation. J Cataract Refract Surg. 1987;13:204–6.CrossRefPubMedGoogle Scholar
  13. 13.
    Ruit S, Paudyal G, Gurung R, Tabin G, Moran D, Brian G. An innovation in developing world cataract surgery: sutureless extracapsular cataract extraction with intraocular lens implantation. Clin Experiment Ophthalmol. 2000;28:274–9.CrossRefPubMedGoogle Scholar
  14. 14.
    Girard LJ, Rodriguez J, Mailman ML. Reducing surgically induced astigmatism by using a scleral tunnel. Am J Ophthalmol. 1984;97(4):450–6.CrossRefPubMedGoogle Scholar
  15. 15.
    Singer JA. Frown incision for minimizing induced astigmatism after small incision cataract surgery with rigid optic intraocular lens implantation. J Cataract Refract Surg. 1991;17:677–88.CrossRefPubMedGoogle Scholar
  16. 16.
    Lam DS, Rao SK, Fan AH, Congdon NG, Wong V, Liu Y, Lam PT. Endothelial cell loss and surgically induced astigmatism after sutureless large-incision manual cataract extraction (SLIMCE). Arch Ophthalmol. 2009;127:1284–9.CrossRefPubMedGoogle Scholar
  17. 17.
    Gokhale NS, Sawhney S. Reduction in astigmatism in manual small incision cataract surgery through change of incision site. Indian J Ophthalmol. 2005;53:201–3.CrossRefPubMedGoogle Scholar
  18. 18.
    Corydon L, Thim K. Continuous circular capsulorhexis and nucleus delivery in planned extracapsular cataract extraction. J Cataract Refract Surg. 1991;17:628–32.CrossRefPubMedGoogle Scholar
  19. 19.
    Thim K, Krag S, Corydon L. Hydroexpression and viscoexpression of the nucleus through a continuous circular capsulorrhexis. J Cataract Refract Surg. 1993;19:209–12.CrossRefPubMedGoogle Scholar
  20. 20.
    Bellucci R, Morselli S, Pucci V, Bonomi L. Nucleus viscoexpression compared with other techniques of nucleus removal in extracapsular cataract extraction with capsulorhexis. Ophthalmic Surg. 1994;25:432–7.PubMedGoogle Scholar
  21. 21.
    Bayramlar H, Cekiç O, Totan Y. Manual tunnel incision extracapsular cataract extraction using the sandwich technique. J Cataract Refract Surg. 1999;25:312–5.CrossRefPubMedGoogle Scholar
  22. 22.
    Hennig A, Kumar J, Yorston D, Foster A. Sutureless cataract surgery with nucleus extraction: outcome of a prospective study in Nepal. Br J Ophthalmol. 2003;87:266–70.PubMedCentralCrossRefPubMedGoogle Scholar
  23. 23.
    Hennig A, Kumar J, Yorston D, Foster A. Use of the anterior chamber maintainer in anterior segment surgery. J Cataract Refract Surg. 1996;22:172–7.CrossRefGoogle Scholar
  24. 24.
    Wright M, Chawla H, Adams A. Results of small incision extracapsular cataract surgery using the anterior chamber maintainer without viscoelastic. Br J Ophthalmol. 1999;83:71–5.PubMedCentralCrossRefPubMedGoogle Scholar
  25. 25.
    Nishi O. A new type of irrigating cannula for lens nucleus delivery by extracapsular extraction. Ophthalmic Surg. 1986;17:47–9.PubMedGoogle Scholar
  26. 26.
    Bartov E, Isakov I, Rock T. Nucleus fragmentation in a scleral pocket for small incision extracapsular cataract extraction. J Cataract Refract Surg. 1998;24:160–5.CrossRefPubMedGoogle Scholar
  27. 27.
    Kansas PG, Sax R. Small incision cataract extraction and implantation surgery using a manual phacofragmentation technique. J Cataract Refract Surg. 1988;14:328–30.CrossRefPubMedGoogle Scholar
  28. 28.
    Venkatesh R, Tan CSH, Sengupta S, Ravindran RD, Krishnan KT, Chang DF. Phacoemulsification versus manual small-incision cataract surgery for white cataract. J Cataract Refract Surg. 2010;36:1849–54.CrossRefPubMedGoogle Scholar
  29. 29.
    Keener GT. The nucleus division technique for small incision cataract extraction. In: Rozakis GW, editor. Cataract surgery: alternative small incision techniques. 1st ed. New Delhi: Jaypee Brothers; 1995. p. 163–91.Google Scholar
  30. 30.
    Rao SK, Lam DS. A simple technique for nucleus extraction from the capsular bag in manual small incision cataract surgery. Indian J Ophthalmol. 2005;53:214–5.CrossRefPubMedGoogle Scholar
  31. 31.
    Ruit S, Tabin G, Chang DF, Bajracharya L, Kline DC, Richheimer W, Shrestha M, Paudyal G. A prospective randomized clinical trial of phacoemulsification vs manual sutureless small-incision extracapsular cataract surgery in Nepal. Am J Ophthalmol. 2007;143:32–8.CrossRefPubMedGoogle Scholar
  32. 32.
    Gogate PM, Kulkarni SR, Krishnaiah S, Deshpande RD, Shilpa A, Joshi SA, Palimkar A, Deshpande MD. Safety and efficacy of phacoemulsification compared with manual small-incision cataract surgery by a randomized controlled clinical trial: six-week results. Ophthalmology. 2005;112:869–74.CrossRefPubMedGoogle Scholar
  33. 33.
    George R, Rupauliha P, Sripriya AV, Rajesh PS, Vahan PV, Praveen S. Comparison of endothelial cell loss and surgically induced astigmatism following conventional extracapsular cataract surgery, manual small-incision surgery and phacoemulsification. Ophthalmic Epidemiol. 2005;12:293–7.CrossRefPubMedGoogle Scholar
  34. 34.
    Muralikrishnan R, Venkatesh R, Manohar BB, Venkatesh PN. A comparison of the effectiveness and cost effectiveness of three different methods of cataract extraction in relation to the magnitude of post-operative astigmatism. Asia Pacific J Vol. 2003;15:33–40.Google Scholar
  35. 35.
    Kimura H, Kuroda S, Mizoguchi N, Terauchi H, Matsumura M, Nagata M. Extracapsular cataract extraction with a sutureless incision for dense cataracts. J Cataract Refract Surg. 1999;25:1275–9.CrossRefPubMedGoogle Scholar
  36. 36.
    Reddy B, Raj A, Singh VP. Site of incision and corneal astigmatism in conventional SICS versus phacoemulsification. Ann Ophthalmol (Skokie). 2007;39:209–16.CrossRefGoogle Scholar
  37. 37.
    Haripriya A, Chang DF, Reena M, Shekhar M. Complication rates of phacoemulsification and manual small-incision cataract surgery at Aravind Eye Hospital. J Cataract Refract Surg. 2012;38:1360–9.CrossRefPubMedGoogle Scholar
  38. 38.
    Venkatesh R, Tan CSH, Singh GP, Veena K, Krishnan KT, Ravindran RD. Safety and efficacy of manual small incision cataract surgery for brunescent and black cataracts. Eye. 2009;23:1155–7.CrossRefPubMedGoogle Scholar
  39. 39.
    Venkatesh R, Das M, Prashanth S, Muralikrishnan R. Manual small incision cataract surgery in eyes with white cataracts. Indian J Ophthalmol. 2005;54:181–4.Google Scholar
  40. 40.
    Venkatesh R, Tan CSH, Kumar TT, Ravindran RD. Safety and efficacy of manual small incision cataract surgery for phacolytic glaucoma. Br J Ophthalmol. 2007;91:279–81.PubMedCentralCrossRefPubMedGoogle Scholar
  41. 41.
    Ramakrishanan R, Maheshwari D, Kadar MA, Singh R, Pawar N, Bharathi M. Visual prognosis, intraocular pressure control and complications in phacomorphic glaucoma following manual small incision cataract surgery. Indian J Ophthalmol. 2010;58:303–6.PubMedCentralCrossRefPubMedGoogle Scholar
  42. 42.
    Venkatesh R, Muralikrishnan R, Balent LC, Prakash SK, Prajna NV. Outcomes of high volume cataract surgeries in a developing country. Br J Ophthalmol. 2005;89:1079–83.PubMedCentralCrossRefPubMedGoogle Scholar
  43. 43.
    Balent LC, Narendran K, Patel S. High volume suture less intraocular lens surgery in a rural eye camp in India. Ophthalmic Surg Lasers. 2001;32:446–55.PubMedGoogle Scholar
  44. 44.
    Muralikrishnan R, Venkatesh R, Venkatesh PN, Frick KD. Economic cost of cataract surgery procedures in an established eye care centre in southern India. Ophthalmic Epidemiol. 2004;11:369–80.CrossRefPubMedGoogle Scholar
  45. 45.
    Gogate P, Deshpande M, Nirmalan PK. Why do phacoemulsification? Manual small-incision cataract surgery is almost as effective, but less expensive. Ophthalmology. 2007;114:965–8.CrossRefPubMedGoogle Scholar
  46. 46.
    Trivedy J. Outcomes of high volume cataract surgeries at a Lions Sight first Eye Hospital in Kenya. Nepal J Ophthalmol. 2011;3:31–8.PubMedGoogle Scholar
  47. 47.
    Abell RG, Vote BJ. Cost-effectiveness of femtosecond laser-assisted cataract surgery versus phacoemulsification cataract surgery. Ophthalmology. 2014;121:10–6.CrossRefPubMedGoogle Scholar
  48. 48.
    Gogate PM, Deshpande M, Wormald RP, Deshpande R, Kulkarni SR. Extracapsular cataract surgery compared with manual small incision cataract surgery in community eye care setting in western India: a randomised controlled trial. Br J Ophthalmol. 2003;87:667–72.PubMedCentralCrossRefPubMedGoogle Scholar

Copyright information

© Springer International Publishing Switzerland 2016

Authors and Affiliations

  • Venkatesh Rengaraj
    • 1
  • Steven S. Ma
    • 2
  • David F. Chang
    • 3
    Email author
  1. 1.Aravind Eye HospitalThavalakuppamIndia
  2. 2.Pacific University College OptometryLos AngelesUSA
  3. 3.Department of OphthalmologyUniversity of California San FranciscoLos AltosUSA

Personalised recommendations