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Intratunnel Phacofracture Technique of the Manual Small Incision Cataract Surgery

  • Intratunnel Phacofracture for Neutralizing Pre Existing Corneal Astigmatism (Toricity) by planning incisions
  • Surgical Induced astigmatism (SIA) Multifocal Vision By Mono Focal IOL
Intratunnel phacofracture technique is a new technique of the manual small incision cataract surgery (MSICS).In this technique nucleus is broken inside the 4 to 6 mm wide sclero-corneal tunnel with the help of the Lewis lens loop. MSICS is significantly faster, less expensive, and less technology-dependent than phacoemulsification and has been extensively practiced in developing countries such as India. However, the drawback of most commonly practiced MSICS techniques Blumenthal, visco-expression, irrigating wire vectis, and fish-hook needle is that they all require a large incision of 7 to 9 mm, which leads to induced astigmatism. The Intratunnel phacofracture technique was innovated by Dr Sudhir Singh1,2.
Post surgery astigmatism is produced by incisions called as Surgical Induced astigmatism (SIA). SIA is related to  incision size, shape, location. The amplitude of the SIA  produced by intratunnel phacofracture is given table 1.

Table 1:Surgical Induced Astigmatism of various size of sclero-corneal incisions

Incision Planning video


Pre operatively most of the corneas have pre existed astigmatism (PEA) of various amplitude.This PEA is effectively neutralized simply choosing incision size and site (Table 2).On the contrary in phacoemulsification we require costly toric intra ocular lenses


Table 2:Pre pre existed astigmatism neutralizing incision normogram

Surgically Induced Astigmatism (SIA) Induced Multifocal Vision By Monofocal IOL
 If surgical induced astigmatism is planned such a way that there is a simple myopic astigmatism of -0.75D to -1.25D vertical axis or compound myopic astigmatism of -0.25 D Sph -1.00 Cyl at vertical axis or compound myopic astigmatism of -0.50 D Sph -0.75 Cyl at vertical axis or mixed astigmatism of +0.50 Sph -1.25 Cyl vertical axis gives multifocal vision by a monofocal IOL(Image1}.This SIA induce  multi focal vision free from side effects of the multifocal IOL like halos, ghost images. So it eliminate the side effects and heavy cost of the multifocal.

Image 1:SIA induce  multifocal vision illustration

Video Cases

1.Singh S. First postoperative day visual outcome following 6 mm manual small incision cataract surgery using intratunnel phacofracture technique. US Ophthalmic Review. 2014;7(1):26-30.
2.Singh Sudhir. Step-by-step: Intratunnel Phacofracture. Cataract & Refractive Surgery Today Europe | MAY 2016:48-51
Intratunnel Phacofracture Manual Small Incision Cataract Surgery (MSICS) Video

How To Plan Incisions In MSICS
4 mm Intratunnel Phacofracture Manual Small Incision Cataract Surgery (MSICS) Video


Intratunnel Phacofracture Technique  In Difficult Cataracts Cases Scenario


Manual Small Incision Cataract Surgery (MSICS or Manual SICS) Video


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