Endoexpression technique of nucleus delivery in manual small-incision cataract surgery

Manual small-incision cataract surgery (MSICS) is a cost-effective alternative to phacoemulsification and extracapsular cataract extraction (ECCE) for cataract surgery. The surgical technique in MSICS is heterogeneous, and the maximum variation exists in incision and nucleus delivery techniques. Many studies on various incisions are available, and most of them are dedicated to surgically induced astigmatism (SIA), utility, and visual outcomes. The nucleus delivery techniques have less-extensive literature available. They can be divided into “pulling” techniques like phacosandwich technique, fish hook technique, and vectis delivery and “pushing” techniques like viscoexpression or hydroexpression with irrigating vectis/Blumenthal’s MiniNuc technique. Postoperative surgical-induced astigmatism is comparable in all techniques. The authors describe a pushing technique which does not raise the pressure of the anterior chamber and can be utilized with variable-sized and irregularly shaped nuclear fragments. It has universal application, especially when the size of the incision is getting smaller in MSICS and phacofragmentation is being used as an adjunct to reduce the incision size. It can be used in situations like posterior polar cataracts, where pressure variations in the anterior chamber can be dangerous.