Preoperative Preparation for Small Incision Cataract Surgery (SICS)

Small Incision Cataract Surgery (SICS) is a manual, sutureless technique widely used in resource-limited settings. Proper preoperative preparation ensures safety, efficiency, and optimal outcomes.

1. Patient Evaluation & Selection


A. Medical History

  • Ocular History:

    • Duration & progression of cataract.

    • Previous eye surgeries/trauma.

    • History of glaucoma, uveitis, or retinal disease.

  • Systemic History:

    • Diabetes, hypertension (controlled?).

    • Bleeding disorders (e.g., on anticoagulants?).

    • Chronic respiratory/cardiac conditions.


B. Ocular Examination

  • Visual Acuity (UCVA & BCVA).

  • Slit-Lamp Exam:

    • Corneal clarity (rule out keratitis).

    • Lens density (nuclear, cortical, posterior subcapsular).

  • Pupil Dilation (assess dilation adequacy).

  • Intraocular Pressure (IOP) (rule out glaucoma).

  • Fundus Exam (if possible, check for retinal issues).



C. Biometry & IOL Power Calculation

  • Keratometry (manual/automated).

  • A-Scan Ultrasound (axial length measurement).

  • IOL Formula (SRK-II, SRK-T, or Holladay).

  • Target Refraction (usually emmetropia or slight myopia).



2. Preoperative Investigations


  • Blood Pressure (ensure <180/110 mmHg).

  • Blood Glucose (if diabetic, ideally <200 mg/dL).

  • ECG (if cardiac risk factors).

  • HbA1c (if uncontrolled diabetes).


3. Preoperative Medications


A. Prophylactic Antibiotics

  • Topical Antibiotic (e.g., Moxifloxacin 0.5% or Gatifloxacin 0.3%) – 4 times/day for 3 days pre-op.


B. Anti-inflammatory Agents

  • NSAID Eye Drops (e.g., Bromfenac, Nepafenac) – to prevent intraoperative miosis & postoperative inflammation.


C. Mydriatics & Cycloplegics

  • Tropicamide 1% + Phenylephrine 5% (30 mins before surgery for pupil dilation).


D. Anesthesia Considerations

  • Peribulbar/Retrobulbar Block (Lidocaine 2% + Bupivacaine 0.5% + Hyaluronidase).

  • Topical Anesthesia (if patient cooperative, e.g., Lignocaine 2% gel).


4. Preoperative Counseling & Consent


  • Explain procedure, risks (posterior capsular rupture, endophthalmitis), and benefits.

  • Discuss monovision (if planned) and IOL options (monofocal, toric).

  • Informed written consent.


5. Preoperative Fasting & Hygiene


  • Fasting: 4-6 hrs for solids, 2 hrs for liquids (if under sedation).

  • Face Wash: Povidone-iodine 5% scrub around the eye.

  • Eyelash Trimming (if long lashes obstruct surgical field).


6. Operating Room (OR) Preparation


  • Sterile draping & speculum placement.

  • Povidone-iodine 5% drops in conjunctival sac (antisepsis).


7. Special Considerations

  • Diabetics: Avoid prolonged fasting; monitor glucose.

  • Anticoagulants (e.g., Aspirin, Warfarin): Usually continued (low bleeding risk in SICS).

  • Hard Cataracts (Brunsonian/Black Cataract): May need extra viscoelastic or capsular stain (trypan blue).

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