In many countries where dense, brunescent cataracts are common, the SICS (small incision cataract surgery) or MSICS (manual small incision cataract surgery) techniques are very popular. These are upgraded and evolved versions of the traditional manual extra-capsular cataract extraction (ECCE) technique with many important upgrades.
The main upgrade is an incision that is carefully shelved so that there is a sufficient tunnel length to provide good closure with few, if any, sutures. The incision is also trapezoidal or funnel shaped with the internal opening larger than the scleral opening. This technique is excellent for truly dense, brunescent cataracts because no ultrasound energy is used to remove the cataract and this can be gentler to the corneal endothelium. Keep in mind that if you are concerned with the refractive outcome of the case, the larger incision used in MSICS will induce far more astigmatism than the typical 2.2 to 2.8 mm phaco incision.
In the USA, particularly at our resident training programs, we frequently teach this MSICS technique. This is certainly the case at our program at the Jules Stein Eye Institute and Olive View UCLA Medical Center, both part of the UCLA School of Medicine in Los Angeles. This is also taught at the Bascom Palmer Eye Institute at the University of Miami in Florida and this video is from a resident training at that program.
