Purpose
To measure forces generated during major steps of manual small incision cataract surgery
Methods
14 eyes underwent MSICS surgery by the same surgeon. A force-sensing transducer probe attached to surgical instruments was used to measure the force generated during the major steps of the surgery. Forces generated during horizontal, vertical and antero-posterior maneuvers were recorded. All feedback from the transducer was correlated with video footage of the surgical steps (Fig 1.). Forces were measured during scleral tunneling, paracentesis entry, anterior chamber entry through the scleral tunnel, capsulotomy, lens vectis assisted lens removal and IOL dialing.
Results
Scleral tunneling produced an average force of 48.6g (range 115.8-4.8). Paracentesis incision produced an average force of 23.4g (range 55.6-13.). Anterior chamber entry through the scleral tunnel produced an average force of 22.9g (range 52.0- 2.1). No significant forces were noted during lens capsule dissection; however repositioning forces were recorded as an average force of 23.6g (range 48.0-10.9). Lens vectis assisted removal of the cataractous lens averaged 35.1g (range 66.3-7.8). Sinskey hook assisted IOL dialing produced an average force of 4.7g (range 7.4-1.6).
Conclusions
This unique technique detects significant and variable forces that are produced during an MSICS procedure. The maximum force generated during this surgery is detected during scleral tunnel construction and the minimum force is generated during anterior lens capsule engagement. A careful recording and study of intraoperative forces will be a helpful guide for generating a haptic (tactile) based MSICS surgical simulator.
Keywords: 445 cataract •
716 small incision cataract surgery •
708 sclera