The role of MSICS and how surgeons should learn

Ranzco has published a review worth reading regarding the role of manual small incision cataract surgery in developed nations.
  
van Zyl L, Kahawita S, Goggin M. Manual small incision extracapsular cataract surgery in Australia. Clin Experiment Ophthalmol 2014; 42: 729–33.
 
This editorial points out the inherent problems that exist when many varying techniques are lumped into one group labeled as "MSICS".  The differences can be quite significant when comparing 5 mm to 8 mm incisions and when comparing viscoelastic free Blumenthal cases vs standard sutureless expression techniques where methylcellulose or another viscoelastic is used.
 
On the topic of surgically induced astigmastism, it would be helpful to see more published results of postop astigmatism across the variety of techniques.  Global Sight would be happy to organize these results here for our community to view and discuss.
 
Also discussion on the learning curve of these techniques is welcome as the authors of the editorial propose that the learning curve is not necessarily an easy one.  
 
In addition, another important discussion revolves around the best method for trainees to gain experience and expertise with these techniques.  Gogate and Thomas discuss that "for obvious reasons, we are against surgeons attempting to learn such procedures in an uncontrolled manner during overseas service delivery missions."  This statement may also present a good point for discussion in regards to what the obvious reasons are and if there might be variables that change this statement such as the quality of the trainer that is also on the mission, the prior experience of the surgeon learning and the monitoring of cases that is involved.
 
Feel free to discuss this in our comment's section.
 
 

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