Manual small incision cataract surgery: An ergonomic solution to tackle cataract backlog and challenging situations

Table 1 Search terms for the present review

Number	Search term
1	Manual small incision cataract surgery
2	Cataract surgery
3	Cataract extraction
4	Ocular anesthesia
5	Sclerocorneal tunnel
6	Capsulotomy
7	Hydrodissection
8	Hydroprolapse
9	Nuclear rotation
10	Viscoelastic substances
11	Viscoexpression
12	Snare
13	Nucleofractis
14	Nuclear bisection
15	Trisection
16	Cortex
17	Hydroimplantation
18	Irrigation
19	Aspiration
20	Posterior capsule rupture
21	Vitreous loss
22	Endophthalmitis

Table 2 Key Differences between manual small incision cataract surgery and phacoemulsification

Criterion	Manual small incision cataract surgery	Phacoemulsification
Anesthesia	Peribulbar, subtenon, topical augmented with subtenon	Topical, peribulbar, subtenon, topical augmented with intracameral
Superior rectus bridle suture	Optional	Not required
Conjunctival peritomy	Optional	Not required
Incision size	2-12 mm	Usually < 3 mm
Anterior capsulotomy	Can-opener, envelope, CCC	CCC
Viscoelastics	Usually low viscosity dispersive or cohesive	High viscosity dispersive required for harder cataracts
Nuclear removal	Wire vectis, Blumenthal, viscoexpression, hydroexpression, Fishhook, snare (nuclear fragmentation)	Ultrasonic emulsification and aspiration
Cortex removal	Simcoe cannula and modifications	Coaxial or bimanual automated, simcoe cannula less commonly
Machine dependence	No	Yes
Overall costs	Lower	Higher

CCC: Continuous curvilinear capsulorhexis.