SICS made simple for medical students
Summary
TLDRIn 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
👨⚕️ 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.
🛠️ 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.
Mindmap
Keywords
💡Cataract Surgery
💡Small Incision Cataract Surgery (SICS)
💡Anesthesia
💡Universal Wire Speculum
💡Conjunctival Peritomy
💡Scleral Tunnel Incision
💡Capsulotomy
💡Hydro Procedures
💡Irrigation Aspiration
💡Intraocular Lens (IOL)
💡Bipolar Cautery
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
you saw subscribe to my channel
and hit the bell icon to never miss an
update from ap's five minute of the
emoji pulse
you may watch my other videos by
clicking on the thumbnails
please leave a note in the comment
section if you wish for any particular
topic to be covered in future
look forward to weekly updates thank you
for watching
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