Nishant P, Singh A, Morya AK, Alam MA, Sinha S. Manual small incision cataract surgery: An ergonomic solution to tackle cataract backlog and challenging situations. World J Methodol 2025; 15(4): 104529 [DOI: 10.5662/wjm.v15.i4.104529]
Corresponding Author of This Article
Arvind K Morya, MD, Professor, Department of Ophthalmology, All India Institute of Medical Sciences, Bibi Nagar, Hyderabad 508126, Telangana, India. bulbul.morya@gmail.com
Research Domain of This Article
Ophthalmology
Article-Type of This Article
Review
Open-Access Policy of This Article
This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
World J Methodol. Dec 20, 2025; 15(4): 104529 Published online Dec 20, 2025. doi: 10.5662/wjm.v15.i4.104529
Manual small incision cataract surgery: An ergonomic solution to tackle cataract backlog and challenging situations
Prateek Nishant, Arshi Singh, Arvind K Morya, Md Afroz Alam, Sony Sinha
Prateek Nishant, Department of Ophthalmology-Refractive Surgery, Uvea and Neuro-Ophthalmology, Akhand Jyoti Eye Hospital, Saran 841219, Bihar, India
Arshi Singh, Department of Ophthalmology, Guru Nanak Eye Center, New Delhi 110001, India
Arvind K Morya, Department of Ophthalmology, All India Institute of Medical Sciences, Hyderabad 508126, Telangana, India
Md Afroz Alam, Department of Ophthalmology-Cataract and Cornea, Akhand Jyoti Eye Hospital, Saran 841219, Bihar, India
Sony Sinha, Department of Ophthalmology-Vitreo-Retina, Neuro-Ophthalmology and Oculoplasty, All India Institute of Medical Sciences, Patna 801507, Bihar, India
Author contributions: Nishant P, Singh A, and Morya AK wrote the manuscript; Morya AK conceptualized the research and submitted the final edited version; Singh A and Alam MA provided the clinical material; Nishant P and Sinha S revised the manuscript; Nishant P, Singh A, Morya AK, Alam MA, and Sinha S performed the literature review; All authors read and approved the final version of the manuscript submitted.
Conflict-of-interest statement: The authors have no conflicts of interest to declare.
Open Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Arvind K Morya, MD, Professor, Department of Ophthalmology, All India Institute of Medical Sciences, Bibi Nagar, Hyderabad 508126, Telangana, India. bulbul.morya@gmail.com
Received: December 24, 2024 Revised: March 19, 2025 Accepted: March 20, 2025 Published online: December 20, 2025 Processing time: 224 Days and 5.7 Hours
Abstract
Cataract surgery is still the most common surgery performed worldwide. It has evolved tremendously in terms of incision, from 12 mm to 1.8 mm, in terms of capsulotomy from envelope type to automated capsulorhexis, and from rigid intraocular lens to foldable intraocular lenses. Manual small incision cataract surgery (MSICS) remains a valuable technique, particularly in rural and underserved areas, due to its cost-effectiveness and simplicity. Its low logistics and favorable outcomes are particularly useful for managing the cataract backlog in developing countries. This review highlights the history and evolution of MSICS, and the reasons for the advent and popularity of this technique, especially in developing countries. It reviews the various recent modifications of the technique, for example, from a superior incision approach to temporal incision to customized MSICS, 2 mm MSICS, and astigmatism-correcting MSICS. It provides an overview of its applicability in complicated scenarios (viz., small pupil, compromised cornea, pseudoexfoliation, subluxated cataract, etc.). It briefly reviews the clinical trials on MSICS and its comparison with phacoemulsification. Finally, the review emphasizes why every ophthalmic surgeon must know MSICS, its relevance in postgraduate teaching, and the role of MSICS simulators for the same. Overall, the review presents a comprehensive picture of the present status of this technique in the surgical armamentarium of ophthalmology.
Core Tip: Cataract surgery is the most common surgery performed worldwide. It has evolved tremendously in terms of incision, from 12 mm to 1.8 mm, in terms of capsulotomy from envelope type to automated capsulorhexis, and from rigid intraocular lens to foldable intraocular lenses. Manual small incision cataract surgery remains a valuable technique, particularly in rural and underserved areas, due to its cost-effectiveness and simplicity. Its low logistics and favorable outcomes are particularly useful for managing the cataract backlog in developing countries. This review provides a comprehensive picture of the current status of this technique in the surgical armamentarium of ophthalmology.
