Background: This video is relevant for beginners to identify and manage intraop complications in SICS independently. Purpose: Educational video on ways to manage full-thickness scleral incision independently and ensure good wound management and closure. 1 Synopsis: This video demonstrates different techniques for the management of full-thickness scleral incision during SICS tunnel construction, with the help of case-based scenarios. The primary reason for this complication is improper handling of the blade while making the initial scleral incision at the start of tunnel construction, leading to exposure of uveal tissue lying underneath. Instead of the ideal partial thickness incision, if the surgeon gives a deep full-thickness cut in the sclera, it leads to complications like iris prolapse and inability to close the wound at the end of surgery. In addition, a deep incision may result in separating the upper sclera from the lower sclera and result in disinsertion. 2-4 Various management strategies can be applied based on the surgeons’ expertise. In the first case scenario, the thickness of the incision is irregular, and the surgeon must ensure to extend the tunnel where the incision is in the superficial plane. Then, through the same plane, careful keratome entry is done followed by closing the tunnel with 10’0 nylon to prevent wound leak and proper formation of the anterior chamber. Incisions with poor integrity should be sutured to minimize the occurrence of Surgical Induced Astigmatism (SIA) and endophthalmitis. 1 The second case scenario focuses on the inability to extend the tunnel and visible viscoelastic leaking from the incision site. In such cases, a side port is made; careful capsulorhexis must be done after staining the capsule with trypan blue and adequate use of viscoelastic. The primary incision site is closed with 10’0 nylon suture, and the incision site is shifted temporally. Rest steps are performed as for standard SICS, with nucleus extraction done by the phaco-sandwich method with the help of Vectis and Dialer. If the operating surgeon has good command of phacoemulsification, one can convert the surgery into clear corneal phacoemulsification surgery. Highlights: Different management options include making a superficial tunnel, converting into a temporal section, or clear corneal phacoemulsification surgery. Iris should never be disturbed to prevent iris-related complications. One must master good suturing skills. Video Link: https://youtu.be/02Fmrnxip5w
Kalamkar et al. (Wed,) studied this question.