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

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.