SICS made simple for medical students

Summary

In this five-minute video, viewers are introduced to the fundamentals of Small Incision Cataract Surgery (SICS). The procedure is explained step-by-step, starting from anesthesia and eyelid separation to the intricate triplanar incision technique. The video covers various types of incisions, capsulotomy methods, and nucleus removal strategies, including hydro procedures and viscoexpression. It concludes with the placement of an intraocular lens and post-operative care, offering a comprehensive overview of the SICS process.

Takeaways

• 😀 The video is an educational piece on small incision cataract surgery (SICS), providing a quick overview in under five minutes.
• 👨‍⚕️ The surgical technique is demonstrated for the right eye, with the surgeon operating from the head end of the patient.
• 👁️ A universal wire speculum is used to keep the eyelids apart for better surgical exposure.
• 🩸 Superior rectus bridle suture is applied to turn the eyeball slightly to maximize exposure for the surgery.
• 🔪 The conjunctiva is opened using conjunctival scissors, creating a based flap towards the fornix to allow access to the sclera.
• 💉 A triplanar incision is made, which is self-sealing and therefore does not require sutures.
• 📏 The first plane of the incision is made at 30 to 50 percent of scleral depth, 1.5 to 2 millimeters from the limbus.
• 📐 Three types of incisions can be made in SICS: frown, straight, and chevron, with the chevron producing the least astigmatism but being technically challenging.
• 🌈 Capsule staining with trypan blue is optional and helps in visualizing the anterior capsule, especially in white cataract cases.
• 🔄 Continuous curvilinear capsular ring (CCC) is the preferred method for capsulotomy in SICS.
• 🌊 Hydro procedures like hydrodissection and hydrodelineation are used to separate and reduce the lens nucleus for easy removal.
• 🔧 Various techniques such as vectus, viscoexpression, and phacoemulsification (phaco) are used to remove the lens nucleus through the small incision.
• 🛠️ After nucleus removal, the cortex is aspirated using a Simcoe cannula, and a posterior chamber intraocular lens (IOL) is implanted.

Q & A

What is the main topic of the video 'AP's Five Minute of the Emoji Pearls'?

The main topic of the video is the basics of Small Incision Cataract Surgery (SICS).

Which eye is demonstrated for the surgical technique in the video?

The surgical technique is demonstrated with respect to the right eye.

What is the purpose of the universal wire speculum used during the surgery?

The universal wire speculum is used to keep the eyelids apart, allowing easy exposure for the surgery.

What is a superior rectus bridle suture used for in the surgical procedure?

A superior rectus bridle suture is applied to turn the eyeball slightly inferiorly to maximize surgical exposure.

What is the purpose of the conjunctival peritomy during the surgery?

The conjunctival peritomy is performed to open the conjunctiva and create a flap that is reflected towards the phornix, allowing for better surgical access.

What is a triplanar incision in the context of SICS?

A triplanar incision in SICS is a self-sealing incision made in three planes: the first plane at 30 to 50 percent of scleral depth, the second plane as a skeletal tunnel into the cornea, and the third plane for entry into the anterior chamber.

What are the three types of incisions that can be made in SICS, and which one produces the least amount of astigmatism?

The three types of incisions are the frown, straight, and chevron. The chevron incision produces the least amount of astigmatism.

What is the purpose of injecting viscoelastic into the anterior chamber during SICS?

Viscoelastic is injected to maintain the anterior chamber and to protect the corneal endothelium during the surgery.

What is the role of the capsule staining with trypan blue in the procedure?

Trypan blue staining is optional and used to stain the anterior capsule, making it more easily visible, which is especially useful in cases of white cataract.

What is the preferred method of capsulotomy in SICS, and what is an alternative tool that can be used?

The preferred method of capsulotomy in SICS is a continuous curvilinear capsular excess. An alternative tool that can be used is a 26 gauge needle, referred to as a needle cystitome.

How is the cortex removed after the nucleus in SICS, and what is used for simultaneous irrigation?

The cortex is removed with the help of a Simcoe irrigation aspiration cannula, and simultaneous irrigation is done with balanced salt solution (BSS).

Outlines

00:00

👨‍⚕️ Small Incision Cataract Surgery (SICS) Basics

This paragraph introduces the fundamentals of Small Incision Cataract Surgery (SICS), a procedure that aims to remove the cataract lens and replace it with an intraocular lens. The surgery is demonstrated for the right eye, with the surgeon operating from the head end of the patient. After anesthesia and prepping, a universal wire speculum is used to keep the eyelids apart. A superior rectus bridle suture is applied to maximize surgical exposure. The conjunctiva is opened using conjunctival scissors, and a triplanar incision is made at the limbus, creating a self-seizing incision that doesn't require sutures. The paragraph also explains the types of incisions used in SICS: frown, straight, and chevron, with the chevron being the most technically challenging but producing the least astigmatism. The surgery continues with hydro procedures to free and reduce the nucleus for easy removal through the small incision, using various techniques such as hydro dissection, hydro delineation, and nucleus removal with a wire vectus or viscoexpression. The paragraph concludes with the removal of the cortex using a Simcoe irrigation aspiration cannula.

05:01

🛠️ Post-Surgery Lens Implantation and Closure

The second paragraph details the final steps of the cataract surgery process, focusing on the implantation of a posterior chamber intraocular lens (IOL) into the capsular bag and its proper rotation using a Sinsky hook. After the lens is in place, viscoelastic material is removed, and the side port is closed using stromal hydration. The conjunctiva is then re-opposed with the aid of bipolar cautery. To prevent infection and reduce inflammation, an antibiotic and steroid are injected subconjunctivally. The video concludes with an invitation for viewers to subscribe to the channel, hit the bell icon for updates, and explore other videos through the provided thumbnails. Viewers are also encouraged to leave comments for future topic suggestions and to look forward to weekly updates.

Keywords

💡Cataract Surgery

Cataract surgery is a medical procedure performed to treat cataracts, which are clouding of the eye's natural lens. In the context of the video, it refers to the specific surgical technique being demonstrated, which is Small Incision Cataract Surgery (SICS). The script describes the various steps involved in this procedure, emphasizing its minimally invasive nature and the use of specialized instruments.

💡Small Incision Cataract Surgery (SICS)

SICS is a type of cataract surgery that involves making a smaller incision in the eye compared to traditional cataract surgery. The video script outlines the process of SICS, highlighting its advantages such as reduced recovery time and less risk of complications. The technique is demonstrated with respect to the right eye, showing the surgeon's approach and the instruments used.

💡Anesthesia

Anesthesia refers to the medical procedure of inducing a state of temporary loss of sensation or consciousness for the purpose of painless surgery. In the script, anesthesia is mentioned as the first step in preparing the patient for cataract surgery, ensuring that the patient is comfortable and does not experience pain during the procedure.

💡Universal Wire Speculum

A universal wire speculum is a medical device used in ophthalmic surgery to keep the eyelids apart, providing clear access to the eye for the surgeon. The script describes its use in both right and left eye surgeries, emphasizing its versatility and importance in facilitating the surgical process.

💡Conjunctival Peritomy

Conjunctival peritomy is the surgical procedure of cutting into the conjunctiva, the thin membrane covering the white part of the eye. In the script, it is mentioned as part of the SICS procedure, where a flap is created to allow access to the underlying structures of the eye without causing bleeding, which is then cauterized.

💡Scleral Tunnel Incision

A scleral tunnel incision is a type of incision made in the sclera, the white outer layer of the eye, during cataract surgery. The script describes this as a tri-planar incision, which is self-sealing and does not require sutures. This incision technique is crucial for the SICS procedure, allowing for a minimally invasive approach.

💡Capsulotomy

Capsulotomy is the surgical procedure of making an opening in the capsule of the eye's lens. In the context of the video, a continuous curvilinear capsular excess (CCCE) is the preferred method of capsulotomy in SICS. The script explains that this technique helps in creating a clear path for the removal of the cataract.

💡Hydro Procedures

Hydro procedures refer to the use of balanced salt solution (BSS) to manipulate the lens during cataract surgery. The script describes two types of hydro procedures: hydro dissection, which separates the nucleus from the cortex and capsule, and hydro delineation, which separates the soft epinucleus from the harder main nucleus. These steps are essential for breaking down the lens material for easy removal through the small incision.

💡Irrigation Aspiration

Irrigation aspiration is a technique used in ophthalmic surgery to remove the lens cortex after the nucleus has been extracted. The script mentions the use of a Simcoe irrigation aspiration cannula for this purpose, which helps in cleaning the eye and preparing it for the implantation of an intraocular lens.

💡Intraocular Lens (IOL)

An intraocular lens is a synthetic lens implanted in the eye during cataract surgery to replace the natural lens that has been removed. The script discusses the placement of a posterior chamber IOL in the capsular bag after the removal of the cataract, which helps restore vision by focusing light onto the retina.

💡Bipolar Cautery

Bipolar cautery is a surgical instrument used to seal blood vessels during surgery to prevent bleeding. In the script, it is mentioned as a tool for cauterizing bleeders during the conjunctival peritomy step of the SICS procedure, ensuring a clear and safe surgical field.

Highlights

Introduction to the basics of small incision cataract surgery (SACS) in under 5 minutes.

Orientation of the surgical technique demonstrated for the right eye from the head end of the patient.

Use of a universal wire speculum to keep eyelids apart for easy surgical exposure.

Application of a superior rectus bridle suture to maximize surgical exposure.

Conjunctival peritomy using conjunctival scissors to create a based flap.

Cauterization of bleeders with bipolar cautery during the procedure.

Description of the scleral sensation as a tri-planar, self-seizing incision for suture-less surgery.

Details on the three planes of the triple incision: depth, skeletal tunnel, and anterior chamber entry.

Different types of incisions in SACS: frown, straight, and chevron, with the chevron producing least astigmatism.

Technique of making a frown incision with a number 15 blade or razor blade fragment.

Use of a crescent knife to dissect a scleral tunnel for the second plane of the incision.

Importance of the internal width of the tunnel being greater than the external for maneuverability.

Injection of temporary viscoelastic to maintain the anterior chamber and protect the corneal endothelium.

Optional capsule staining with trypan blue for better visibility, especially in white cataracts.

Continuous curvilinear capsular excess (CCCE) as the preferred method of capsulotomy.

Entering the anterior chamber with a keratome and extending the incision to complete the tunnel opening.

Hydro procedures to free the nucleus from the lens and reduce its size for easy removal.

Techniques for nucleus removal in SICS, including wire vectus and viscoexpression.

FACO fracture technique using a 26 gauge needle to divide and remove the nucleus.

Blue menthol technique for nucleus removal using an anterior chamber maintainer and sheath's glide.

Removal of cortex with a Simcoe irrigation aspiration cannula and posterior chamber intraocular lens placement.

Closure of the side port by stromal hydration and re-opposing the conjunctiva with bipolar cautery.

Final steps including injection of antibiotic and steroid subconjunctivally.

Transcripts

hello viewers welcome to ap's five

minute of this emoji pearls

watch understand and remember anything

in of the emoji

in under five minutes today we will

cover the basics of small incision

cataract surgery or

sacs so first a little bit of

orientation

the surgical technique will be

demonstrated with respect to the right

eye

since the surgeon operates from the head

end of the patient this is a superior

aspect

and this is the inferior aspect after

anesthesia and prepping a universal wire

spectrum is inserted to keep the eyelids

apart

to allow easy exposure for the surgery

it is called universal because it may be

used for both the right and the

left eyes here a superior surgical

approach is demonstrated

a superior rectus bridal suture is

applied while holding the superior

rectus tendon with a dasture

superior rectus forceps so as to turn

the eyeballs slightly inferiorly to

maximize surgical

exposure next is the opening of the

conjunctiva or conjunctival peritomy

using a conjunctival scissors a phonics

based flap is made

that is a flap with an incision at the

zimbas and which is reflected towards

the phonics

bleeders are cauterized with a bipolar

cautery the scleral sensation is a

tri-planar incision which is a

self-seizing incision

therefore this is a suture less surgery

the first plane of the triple in our

incision is made at 30 to 50 percent of

zero depth one point five to two

millimeters from the limbus

the second plane is the skeletal tunnel

which is carried forward about 1.5

millimeters

into their cornea and the third plane is

the plane of entry into the

anterior shape for the first planar

incision three types of incisions can be

made in sscs

they are the frown straight and chevron

what do they look like

this is the frown this is the straight

and this is the

chevron the chevron produces the least

amount of astigmatism but is technically

difficult

and hence not commonly performed here a

frowns

incision is made with a number 15 blade

or a

razor blade fragment a crescent knife is

then used to dissect a squirrel tunnel

to about 1.5 millimeters into clear

cornea

that is the second plane of the

triplinar incision

the internal width of the tunnel should

be greater than that of the

external wind a sideboard incision is

useful for

extra maneuverability and for easy

removal of sub-incisional cortex

it is made with a large blade temporary

viscoelastic is then injected to

maintain the anterior chamber

and to protect the corneal endothelium

capsule staining is optional tripod blue

is injected into the anterior chamber

and washed out after about 30 seconds

this stains the anterior capsule making

it more easily visible

this is especially useful in a white

cataract a continuous curvilinear

capsular excess is the preferred method

of capsulotomy

a bend 26 gauge needle can be used in

which case it is referred to

as a needle cystitome alternately a

uterata forceps may be

used now the anterior chamber is entered

with the kerato this is the third plane

of the triplanar incision

and the incision is extended on either

side to complete the internal opening of

the tunnel

hydro procedures are employed to free

the nucleus from the rest of the lens

and to reduce it is in reduce it in size

to enable easy removal from the small

incision

hydro dissection is performed by

injecting balance salt solution just

under the rexis margin the fluid travels

and separates the nucleus from the

cortex and the

capsule in hydro delineation balanced

solid solution is injected into the mass

of the nucleus

to separate the soft epinucleus from the

harder inner

main nucleus the nucleus is then

prolapsed into the anterior chamber

using a

sinsky hook the nucleus is then removed

from the eye with the help of a

wire vectus

you can see the same thing in the

operating view

the wire vectors is only one of various

ways to remove the nucleus in

sics we shall see some of the others

here the vectors has a provision for

continuous infusion of bss to increase

the pressure in the

anterior chamber and to help push out

the nucleus

in viscoexpression viscoelastic is

injected continuously into the anterior

chamber

instead of bss as the name suggests

the nucleus is sandwiched between a

vectus below and another

instrument such as an iris repositor or

a sinsky hook

above in faco fracture various

instruments are used to divide the

nucleus

into two or more pieces to aid easy

removal

in this technique a 26 gauge needle is

used

to engage the nucleus and remove it the

blue menthol technique makes use of an

anterior chamber maintainer

to maintain a positive pressure in the

anterior chamber

and a sheath's glide to remove the

nucleus

the cortex is then removed with the help

of a simcoe irrigation aspiration

cannula while simultaneous irrigation is

done with

bss viscoelastic is then injected

and a posterior chamber intraocular lens

is placed in the capsular bag

and rotate it into place with the help

of a sinski hook

viscoelastic is removed the side port is

closed by stromal hydration

and the conjunctiva is re-opposed with

the help of a bipolar cautery

an antibiotic and steroid is injected

sub conjunctivally

so that's it for today if you like what

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