A Prospective Study on the Outcomes of Manual Small Incision Cataract Surgery (MSICS) Using the Modified Ruit Technique at Nan Hospital
Keywords:
Modified Ruit technique; Manual small incision cataract surgeryAbstract
Objective: To study the visual outcomes, post-operative astigmatism, and complications of manual small incision cataract surgery (MSICS) using the Modified Ruit technique in the treatment of cataract patients.
Design: Prospective study
Methods: The medical records of 91 patients (91 eyes) with cataracts who underwent MSICS using a temporal scleral tunnel incision (Ruit’s technique) at Nan Hospital between October 2023 and February 2024 were reviewed. All 91 surgeries were performed by a single surgeon. Out of these 20 eyes (20 patients), four eyes missed the six-week follow-up, one eye was subject to incomplete data, seven eyes underwent combined ocular procedures, and eight eyes had pre-operative vision impairing pathology or previous ocular surgery. Records of 71 patients (71 eyes) with pre-operative, post-operative visual acuity (VA), operative time, intraoperative difficulties, intraoperative complication, post-operative complications, and astigmatism were analyzed in the second and sixth week after surgery.
Results: Seventy-one eyes of 71 patients were treated by MSICS using the Modified Ruit technique. Patients achieved excellent surgical outcomes with low complication rates. The post-operative best-corrected visual acuity (BCVA) results at the sixth-week follow-up were 20/20 to 20/40 in 95.8% (68/71) and 20/50 to 20/70 in 4.2% (3/71). At the sixth week after treatment, the mean post-operative astigmatism was -1.14±0.91D. The findings revealed a small risk of surgical complications, with hyphema being the most frequent intraoperative complication in 12.7% (9/71) of patients. No major surgical complications were found.
Conclusion: MSICS using the Modified Ruit technique is a high-quality procedure that achieves excellent clinical outcomes with a low rate of complications.
Keywords: Modified Ruit technique; Manual small incision cataract surgery
References
Bourne RRA, Flaxman SR, Braithwaite T, et al. Magnitude, temporal trends, and projections of the global prevalence of blindness and distance and near vision impairment: a systematic review and meta-analysis. The Lancet Glob Health 2017; 5(9):e888–e97.
Jenchitr W, Harnutsaha P, Iamsirithaworn S, et al. The National survey of blindness, low vision and visual impairment in Thailand 2006–2007. Thai J Pub Health Ophthalmol 2007; 21:10–94.
Astbury N. Converting from ECCE to SICS. Community eye health / International Centre for Eye Health. 2009; 22(69):6–7.
Ruit S, Tabin GC, Nissman SA, et al. Low-cost high-volume extracapsular cataract extraction with posterior chamber intraocular lens implantation in Nepal. Ophthalmology. 1999; 106(10):1887–92.
Hennig A, Kumar J, Yorston D, et al. Sutureless cataract surgery with nucleus extraction: outcome of a prospective study in Nepal.Br J Ophthalmol. 2003; 87(3):266–70.
Venkatesh R, Muralikrishnan R, Balent LC, et al. Outcomes of high-volume cataract surgeries in a developing country. Br J Ophthalmol. 2005; 89(9):1079–83.
Ruit S, Paudyal G, Gurung R, et al. An innovation in developing world cataract surgery: suturelessextracapsular cataract extraction with intraocular lens implantation. Clin Experiment Ophthalmol. 2000; 28(4):274–9.
Ruit S, Tabin G, Chang D, et al. A prospective randomized clinical trial of phacoemulsification vs manual sutureless small-incision extracapsular cataract surgery in Nepal. Am J Ophthalmol. 2007; 143(1):32–8.
Vettorazzi MRP, Rodriguez JBC, Ortiz ERO,et al. Results of Sutureless Manual Small Incision Cataract Surgery in a Low-Income Population. CRO (Clinical & Refractive Optometry) Journal. 2020; 31;314–318.
Waghmare R, Shinde C, Shirwadkar S. A Comparative Study of Pre- and Post-Operative Refractive Errors in Cataract Surgery- Phacoemulsification vs. Manual SICS in a Tertiary Care Hospital. J. Evid. Based Med. Healthc., 2019; 6:3212–3216.
Gogate PM, Kulkarni SR, Krishnaiah S, et al. Safety and efficacy of phacoemulsification compared with manual small-incision cataract surgery by a randomized controlled clinical trial: six-week results. Ophthalmology. 2005; 112:869-–74.
Rathi A, Singh N, Chauhan RS, et al. A Comparative Study to Evaluate Visual Outcome in Post-Operative Patients of Manual Small Incision Cataract Surgery and Phacoemulsification. Saudi Journal of Medical and Pharmaceutical Sciences. Saudi J Med Pharm Sci, 2020; 6:353–358.
Kongsap P. Visual outcome of manual small-incision cataract surgery: Comparison of modified Blumenthal and Ruit techniques. Int J Ophthalmol. 2011; 4:62 5.
Muralikrishnan R, Venkatesh R, Prajna NV, et al. Economic cost of cataract surgery procedures in an established eye care centre in Southern India. Ophthalmic Epidemiol 2004; 11:369–80.
Kamonporn N, Pipat K. The visual outcomes and complications of manual small incision cataract surgery and phacoemulsification: Long term results. Rom J Ophthalmol 2021; 65:31 7.
Gogate P, Ambardekar P, Kulkarni S, et al. Comparison of endothelial cell loss after cataract surgery: Phacoemulsification versus manual small incision cataract surgery: Six-week results of a randomized control trial. J Cataract Refract Surg 2010; 36:247 53.
Venkatesh R, Tan CS, Sengupta S, et al. Phacoemulsification versus manual small incision cataract surgery for white cataract. J Cataract Refract Surg 2010; 36:1849 54.
Cook C, Carrara H, Myer L. Phacoemulsification versus manual small incision cataract surgery in South Africa. S Afr Med J 2012; 102:537 40.
Sharma U, Sharma B, Kumar K, et al. Evaluation of complications and visual outcome in various nucleus delivery techniques of manual small incision cataract surgery. Indian J Ophthalmol. 2019; 67:1073 8.
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