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).