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  • Writer's pictureAtanas Bogoev M.D. and Maria Cholakova

Small Incision Cataract Surgery (SICS)

Manual small incision cataract surgery (SICS a.k.a. MSICS; SECCE) is a surgical technique to remove cataracts with minimal damage to the eye. SICS combines the benefits of extracapsular cataract extraction (ECCE) but with smaller, self-sealing incisions.

SICS Procedure Overview

The steps of a SICS cataract treatment are as follows:

  1. Anesthesia: Local or topical anesthesia to numb the eye.

  2. Incision: The surgeon makes a small, self-sealing incision (6-7 millimeters) in the sclera or cornea.

  3. Capsulotomy: A circular opening is made in the lens capsule to access the cataract.

  4. Lens removal: The eye doctor removes the cataractous lens in two sub-steps:

  • Nucleus extraction: The core of the lens is manually removed through the corneal iincision.

  • Aspiration: The softer outer cortex is then suctioned out, leaving the posterior capsule intact.

  1. Insertion of artificial lens: An intraocular lens (IOL) is implanted into the remaining capsule.

  2. Closure: The small incision is usually self-sealing, so there's rarely need for sutures.

Advantages of Manual Small Incision Cataract Surgery

  • Smaller incision

  • Cost-effective

  • Widely applicable

The smaller incision compared to traditional ECCE leads to faster healing and lower risk of complications. SICS has faster recovery times and less postoperative discomfort than ECCE cataract surgery, but slower recovery than phacoemulsification.

SICS is often more affordable than other surgery options and does not require tech like femtosecond laser assistance. It's effective for dense or mature cataracts which may be challenging for phacoemulsification.

Disadvantages of Manual Small Incision Cataract Surgery

  • Learning curve

  • Larger incision

  • Longer recovery time

  • Risk of induced astigmatism

The main disadvantage of SICS is it calls for specific surgical skills and experience to perform effectively. Then there's the potential for induced astigmatism due to the shape and size of the incision, though less than ECCE.

SICS Indications

SICS is quite suitable for cataract patients who:

  • Have very dense or mature cataracts

  • Look for an inexpensive surgery option

  • Live in areas where advanced technology for phacoemulsification may not be available

Risks and Complications

While small incision cataract surgery tends to be safe, potential risks include:

  • Small chance of infection (endophthalmitis)

  • Increased eye pressure (temporally)

  • Retinal detachment (rare)

  • Artificial lens may move out of place


Small incision cataract surgery (SICS) is a versatile option for cataract removal. The best part is, patients with dense cataracts or in regions where advanced equipment is not available can get adequate treatment with SICS. If you need cataract surgery, consult your eye doctor on the best option for your case.


Checked by Atanas Bogoev, MD.

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