Converting from ECCE to SICS

Introduction Cataract continues to be the cause of almost half the cases of blindness worldwide and the challenge to meet the needs and develop the required resources is as great as ever. Cataract surgery has evolved from couching, first practised several thousand years ago, through intraand extracapsular extraction (ECCE), to phacoemulsification. However, whatever the technique, the most important aspect is the outcome for patients. Today, the focus is more and more on excellence, which was one of the central themes of the 8th General Assembly. Good outcomes depend upon teamwork, appropriate surgical technique, and the expertise of the individual surgeon. Outcomes using small incision ‘non-phaco’ techniques have been encouraging in settings where large volumes of surgery have been undertaken.1 Manual small incision cataract surgery (SICS) offers better outcomes than ECCE and provides results equally as good as phacoemulsification (‘phaco’), while being faster, cheaper, and less dependent on technology.2 It is therefore more appropriate for tackling cataract in lowand middle-income countries. In developing countries, most surgeons are skilled in ECCE and would benefit from training to convert to SICS (see box). The availability of surgical training for SICS is becoming an increasingly important factor: indeed, ‘phaco’ surgeons have become more sophisticated in a technique that is inappropriate for tackling cataract on a global scale, and they are not best placed to teach small incision non-phaco techniques. Increasingly, the focus of expertise in manual SICS is to be found in India, Pakistan, Nepal, Africa, or Latin America. The course on converting from ECCE to SICS featured four surgeons from Paraguay, Ecuador, Nepal, and India, all experts in manual SICS. The speakers offered a glimpse of the variety of SICS techniques which have evolved in different parts of the world and discussed the best way to convert from ECCE to SICS.