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Manual Small Incision Cataract Surgery (MSICS): An effective alternative to Phaco-emulsification. Should residents in Europe learn this surgery?

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First Author: J.Andre FRANCE

Co Author(s):    V. Lansingh   A. Bacchav   C. Ahiwalay   T. Sheth   A. Nair   K. Odusote     

Abstract Details


Manual Small Incision Cataract Surgery (MSICS) is a well-established and practiced technique in the developing world, especially for difficult cataracts or complication cases. The purpose of this communication is to review the available literature to highlight the benefits of MSICS and to explore the role of simulation-based training in MSICS for European resident doctors.


Phacoemulsification is the standard technique for cataract extraction in Europe. Extra-capsular Cataract Extraction is the preferred alternative technique across Europe and MSICS has been largely ignored. Studies have shown MSICS to be as safe as phacoemulsification with equivalent outcomes. Therefore, its role as a valuable alternative method must be explored.


A thorough literature search was done to assess studies focussing on MSICS, and its role as an alternative to phacoemulsifcation. Studies comparing complication rates, visual outcomes and effectiveness of MSCIS vs. ECCE / Phacoemulsification were also reviewed. The review of literature was done based on the following keywords: MSICS , ECCE, phacoemulsification, resident training, residency, conversion.


Most studies show that hard nucleus is a challenge while performing phacoemulsification. The efficiency of MSICS in rock-hard cataracts and complex cases is proven and its outcomes are superior to those of ECCE. Occasionally in complex situations or due to complications, some cases need to be converted from phacoemulsification to ECCE or MSICS. However, MSICS is not taught in Europe, primarily due to the lack of surgeons conversant in MSICS. Newer innovations such as MSICS simulators can potentially help trainees learn this technique effectively.


MSICS is a valuable tool that should be a part of every cataract surgeon’s armamentarium. The possibility simulation-based training in MSICS, now available, should be explored by trainees to acquire the skillsets required; especially in Europe where MSICS is not widely taught.

Financial Disclosure:

... is employed by a for-profit company with an interest in the subject of the presentation

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