Manual Small Incision

Cataract Surgery :

The BEGINNINGNawat Watanachai

Chiangmai University Hospital

RCOPT 2014

Special Thanks to

Associate Prof. Anuchit Poonyathalung, MD

Aektet Chansue, MD

Nawaporn Techamaneesathit, MD

MSICS : Why?

effective and sufficient

Prof. Sanduk

Ruit

Prof. Fred Hollows

Prof. Sanduk

Ruit

2006 Ramon Maysaysay Award

2007 Prince Mahidol Award

2007 Honorary Officer of the Order of Australia for service to

humanity

Prof. Sanduk Ruit

2011 ‘Out of The Darkness’ Movies - Italian director Stefano Levi

2011 BBC documentary series Human Planet, episode 5

2014 Australian documentary dedicated to Fred Hollows

Nepal’s Eye

Problem

not enough eye docs

no eye doc in the remote

areas

poor transportation

system (esp in the

mountainous areas)

poor patients

suffers the pts/ burdens to

the family

170,000 blind people

70% cataract

+30,000 cataract blindness/ year

90% of blind population lives in

remote areas

150 eye docs (1/ 189,000)

90% works in urban areas

Nepal Ministry of Health

Vision 2020, WHO

Nepal’s Eye Problem

The Solution

lower the price

IOL

surgical technique

offer cataract Sx service

to the remote areas

surgical technique

camp surgery

eye doctors

The Solution

lower the price

IOL

surgical technique

offer cataract Sx service

to the remote areas

surgical technique

camp surgery

eye doctors

lower the price : IOL

Prof. Fred Hollows

problem : IOL from major manufacturers are too

pricey

solution : ask for special price from the leading

companies

lower the price : IOL

Prof. Fred Hollows

problem : IOL from major manufacturers are too

pricey

solution : ask for special price from the leading

companiesFAILED!!!!

lower the price : IOL

Prof. Fred Hollows

problem : IOL from major manufacturers are too

pricey

solution : build their own factory!!!!

lower the price : IOL

Prof. Fred Hollows

AUS

Prof. Ruit’s mentor

visited Nepal in 1985 as a

consultant to the WHO

together with Dr. Sanduk

Ruit

set the goal of their lives to

help the blinds

lower the price : IOL

Prof. Fred Hollows

Fred Hollows Foundation

1992

Fred Hollows IOL

Labolatory

Nepal

Eritrea

1990 Australian of the year

1991 Companion of the

order of AUS

lower the price : IOL

Fred Hollows

Foundation

Fred Hollows IOL

Laboratory

1994 opened

computer-ctrl IOL

prod.

got SGS certification

(UK)

1993 Prof. Hollows

passed away

lower the price : IOL

1994 started producing rigid IOL (4 USD/piece)

2005 started producing foldable IOL

>400,000 IOL/Yr

>3.5M IOL

approved supplier for IOL in WHO’s VISION2020 project

on the way

to produce hydrophobic IOL

have their own eye drops factory

lower the price : IOL

>70 Countries in which FHF

IOLs are distributed Bangladesh

Cambodia

China

Egypt

Indonesia

Iran

Malaysia

Mongolia

Myanmar

Pakistan

Philippines

Sri Lanka

South Africa

ThailandVietnam

The Solution

lower the price

IOL

surgical technique

offer cataract Sx service to the remote

areas

surgical technique

camp surgery

eye doctors

Prof. Sanduk Ruit

MSICS

Prof. Sanduk Ruit

MSICS

Cataract Sx Technique

ECCE PE

instrument/ price less more

mobility more less

time of Sx more less

postop. pain/

astig.more less

skill needed less more

Cataract Sx Technique

ECCE PE MSICS

instrument/

priceless more less

mobility more less more

time of Sx more less less

postop. pain/

astig.more less less

skill needed less more less

Cataract Sx Technique

MSICS

instrument/ price less comparable to ECCE

mobility more comparable to ECCE

time of Sx less comparable to PE

postop. pain/ astig. lessin the middle between

ECCE/PE

skill needed lessneeds few adjustment from

ECCE

How MSICS work?

1. conj peritomy

2. curved scleral tunnel

3. V-shape capsulotomy

4. move nucleus into the AC

5. nucleus extraction

6. cortex clean up

7. IOL insertion, remove

capsule

8. close wound

How MSICS work?

1. conj peritomy

2. curved scleral tunnel

3. V-shape capsulotomy

4. move nucleus into the AC

5. nucleus extraction

6. cortex clean up

7. IOL insertion, remove capsule

8. close wound

How MSICS work?

1. conj peritomy

2. curved scleral tunnel

3. V-shape capsulotomy

4. move nucleus into the AC

5. nucleus extraction

6. cortex clean up

7. IOL insertion, remove capsule

8. close wound

How MSICS work?

1. conj peritomy

2. curved scleral tunnel

3. V-shape capsulotomy

4. move nucleus into the AC

5. nucleus extraction

6. cortex clean up

7. IOL insertion, remove capsule

8. close wound

How MSICS work?

1. conj peritomy

2. curved scleral tunnel

3. V-shape capsulotomy

4. move nucleus into the AC

5. nucleus extraction

6. cortex clean up

7. IOL insertion, remove capsule

8. close wound

How MSICS work?

1. conj peritomy

2. curved scleral tunnel

3. V-shape capsulotomy

4. move nucleus into the AC

5. nucleus extraction

6. cortex clean up

7. IOL insertion, remove capsule

8. close wound

How MSICS work?

1. conj peritomy

2. curved scleral tunnel

3. V-shape capsulotomy

4. move nucleus into the AC

5. nucleus extraction

6. cortex clean up

7. IOL insertion, remove capsule

8. close wound many need 0-1 stitch in most

cases

The Solution

lower the price

IOL

surgical technique

offer cataract Sx service to the

remote areas

surgical technique

camp surgery

eye doctors

The Solution

lower the price

IOL

surgical technique

offer cataract Sx service to the

remote areas

surgical technique

camp surgery

eye doctors

Eye Doctors

Tilganga Institute of

Ophthalmology

established in 1994

provide medical

training in over 18

countries

Eye Doctors

Tilganga Institute of Ophthalmology

facilities

Fred Hollows IOL lab

Research department

eye bank

18 outreach microsurgery eye

clinics

looking forward to built eye

medication factory

Eye Doctors

Nepal docs

foreign docs from US, EU, Asia, Aus,

Africa

Programs

Residency program 5X/yr, 3 yrs course

Modular training programs,

specific courses, 1-3 mths course

fellowship, 1 yr course (VR, cornea)

Exposure training programs

medical students

The Solution

lower the price

IOL

surgical technique

offer cataract Sx service

to the remote areas

surgical technique

camp surgery

eye doctors

MSICS : Why?