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Manual Sutureless Cataract Surgery: Dealing with the alphabet soup of acronyms for cataract surgery technique.

spencer2The Global Sight Alliance is focused on the many millions of people in developing countries who lack access to eye care. Most prominent is the effort to provide cataract surgery, as cataract is the leading cause of blindness in virtually all these countries. For delivery of high volume, high quality cataract surgery in these settings the current state of the art is a technique which has many variations, but includes a self-sealing scleral tunnel incision, manual removal of the nucleus, and insertion of a PMMA IOL. The most commonly used name for this procedure, especially in Asia, is Small Incision Cataract Surgery (SICS) or Manual Small Incision Cataract Surgery (MSICS). The name for this technique was generated in India in the late 1990's, and it was appropriate in that time and place because the main cataract surgery techniques in India before that time were standard ECCE and, to a lesser extent, ICCE, both of which entailed incisions larger than 10mm.


Since that time, phaco has become more widely adopted, including in the affluent sectors of developing countries. In its turn, 'SICS' has become the procedure of choice in high volume cataract surgery programs in Asia. Depending on the size of the nucleus and the method of extraction, the incision can be as small as 6mm and as large as 9mm. In these days of Micro Incision Cataract Surgery (MICS), by no stretch of the imagination can this be called a Small Incision. With frequent references in the literature to SICS as meaning standard phaco1,2, it becomes ever more inappropriate to apply the acronym to this manual technique.


A more logical and unambiguous name is required. The characteristic that makes the technique faster, safer, more economical and more efficacious is that the incision is sutureless. Incision size is irrelevant, since improved unaided visual acuity through reduced astigmatism is achieved via appropriate incision shape and placement, not by reducing incision size. Phaco is a form of extracapsular surgery, so ECCE is not an appropriate as part of the name. The logical name is Manual Sutureless Cataract Surgery (MSCS). Use of this label will foster clarity and ease communication among surgeons whether in developing or developed countries.


Any comments are welcome on how you have referred to this procedure and if these thoughts seem to reflect the direction then nomenclature should go.


  1. Hayashi K. Post-operative corneal shape changes: Microincision versus small-incision coaxial cataract surgery. J Cataract Refract Surg 2009; 35:233-239 [SICS used to describe phaco through a 3-4mm incision]

  2. Tong N. Changes in corneal wavefront aberrations in microincision and small-incision cataract surgery. J Cataract Refract Surg2008; 34:2085-2090 [SICS used to describe phaco through a 3mm incision]



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