SICS vs phacoemulsification

Merits of manual SICS over phacoemulsification
1. Universal applicability i.e., all types of cataracts
including hard cataracts (grade IV and V) can be
operated by this technique.
2. Learning curve. This procedure is much easier to
learn as compared to phacoemulsification.
3. Not machine dependent. The biggest advantage
of manual SICS is that it is not machine dependent
and thus can be practised anywhere.
4. Less surgical complications. Disastrous
complication like nuclear drop into vitreous cavity
is much less than phacoemulsification technique.
5. Operating time in manual SICS is less than that
of phocoemulsification, especially in hard cataract.
Therefore, it is ideal for mass surgery.
6. Cost effective. With manual SICS, the expenses
are vastly reduced as compared to considerable
expenses in acquiring and maintaining phaco
machine. There is no need to spend on
consumable items like the phacotip, sleeves,
tubing and probe. Further, in SICS always PMMA
IOLs are used which are much cheeper than
foldable IOLs.
Demerits of manual SICS over phacoemulsification
1. Conjunctival congestion persists for 5-7 days at
the site of conjunctival flap.
2. Mild tenderness sometime may be present owing
to scleral incision.
3. Postoperative hyphaema may be noted
sometimes.
4. Surgical induced astigmatism is more as the
incision in SICS is large (about 6 mm) as compared
to phacoemulsification (about 3.2 mm).
Merits of phacoemulsification over manual SICS
1. Topical anaesthesia may be sufficient for
phacoemulsification in expert hands.
2. Postoperative congestion is minimal after
phacoemulsification, as phaco is usually
performed through a clear corneal incision.
3. Small incision. The chief advantage of
phacoemulsification over manual SICS is that it
can be performed through a smaller (3.2 mm)
incision.
4. Less corneal complications. Phacoemulsification
can be performed in the posterior chamber
without prolapsing the nucleus into the anterior
chamber, thereby minimising the risk of corneal
complications.
5. Visual rehablitation is comparetively quicker in
phacoemulsification as compared to manual SICS.
6. Postoperative astigmatism is comparatively less
when foldable IOLs are implanted through a
smaller incision (3.2 mm).
Demerits of phacoemulsification vis-a-vis manual
SICS
1. Learning curve for phacoemulsification is more
painful both for the surgeons and patients.
2. Complications encountered during phacoemulsification
like nuclear drop are unforgiving.
3. Machine dependent. This procedure is solely
machine dependent and in the event of an
unfortunate machine failure in the middle of
surgery one has to shift to conventional ECCE.
4. High cost. Cost of this technique is very high
because of expensive machine, accessories and
maintenance.
5. Limitations. It is very difficult to deal with hard
cataracts (grade IV and V) with this technique,
and also there is high risk of serious corneal
complications due to more use of phaco energy
in such cases.
Conclusion. Inspite of the demerits listed above
the phacoemulsification has become the preferred
method of cataract extraction world wide because
the complication rate in the expert hands is minimal
and the technique provides an almost quiet eye
early postoperatively and an early visual
rehabilitation. However, for the masses, especially
in developing countries, the manual SICS offers the
advantages of sutureless cataract surgery as a low
cost alternative to phacoemulsification with the
added advantages of having wider applicability and
an easier learning curve.