Small Incision Cataract Surgery (SICS) and Extracapsular Cataract Extraction (ECCE) are two traditional techniques for manual cataract removal, without lasers and advanced tech. While both SICS and ECCE aim to restore clear vision by replacing the cloudy natural lens with an artificial intraocular lens, their approaches, incision sizes, recovery times, and potential complications differ.
SICS and ECCE Cataract Surgery Comparison
Even though phacoemulsification and femtosecond laser-assisted surgeries (FLACS) are the most popular treatment options right now, some advanced cataract cases require manual surgery. So do patients who live in a less privileged areas.
When we talk about the choice SICS vs ECCE, there are key differences between these uncommon manual cataract removals.
Incision Size
SICS:
Small, self-sealing incision, around 6-7 millimeters.
The smaller incision minimizes eye disruptions and rarely requires sutures.
ECCE:
Requires a larger incision, between 9-12 millimeters, to remove the cataractous lens in one piece.
The larger incision often necessitates sutures to close the wound.
Recovery Time
SICS:
Faster recovery time due to the small incision and less trauma to the eye.
Patients often experience less postoperative discomfort and a quicker return to normal activities.
ECCE:
Has a longer recovery period because of the larger incision and the need for sutures.
Patients tend to experience more postoperative discomfort and a slower healing process.
Surgical Technique
SICS:
Combines manual fragmentation of the cataractous lens with an aspiration of the lens pieces.
The technique involves creating a small capsulotomy to access the cataract. Then manually breaking the lens into smaller fragments and suctioning them out.
ECCE:
Involves removing the entire lens nucleus in one piece through a large incision.
The lens capsule is opened, and the cloudy lens is extracted, leaving the posterior capsule intact to support the IOL (intraocular/artificial lens).
Complications
SICS:
Low risk of complications such as infection and induced astigmatism.
Less postoperative discomfort due to the self-sealing incision.
ECCE:
High risk of complications like infection, wound leak, and induced astigmatism.
Sutures used to close the larger incision can also lead to increased postoperative discomfort.
Indications
SICS:
For patients with dense or mature cataracts.
Effective in settings with limited access to advanced surgical technology.
ECCE:
For cases where the cataract is too hard or mature to be safely fragmented with phacoemulsification.
When a larger incision is necessary due to anatomical considerations of the patient’s eye.
In Summary...
When conventional cataract surgery options like phacoemulsification and FLACS are not an option, SICS seems to be a better choice than ECCE. Still, the final decision is not in the hands of the patient. It depends on the considerations of the eye surgeon, who assesses the severeness and type of cataract.
Some people may be eligible for small incision cataract surgery. Yet, others may need a more invasive procedure like extracapsular cataract extraction. In any case, your eye doctor will guide you through the process.
Resources:
Comparing Cataract Surgery Options, RE:VISION
✅ Medically reviewed
Checked by Atanas Bogoev, MD.