A comparative study of intraoperative and postoperative complications and visual outcomes in various techniques of nucleus delivery in manual small incision cataract surgery

Purpose: To compare intraoperative and postoperative outcomes of four nucleus delivery techniques—phacosandwich, irrigating vectis, wire vectis, and viscoexpression—in manual small incision cataract surgery (MSICS). Methods: This is a prospective study on 200 patients undergoing MSICS divided equally into four groups based on the technique used. The parameters observed were age, sex, nuclear grade, intraoperative and postoperative complications, surgically induced astigmatism, and visual acuity at 1 day, 7 days, and 6 weeks postsurgery. Results: The most common intraoperative complication was miosis (19%), predominantly in the phacosandwich group. Wire vectis showed the highest rate of complications overall. On day 1, the viscoexpression and irrigating vectis groups had the fewest corneal sequelae. Postoperative corneal complications declined over time, with 98% of patients showing no issues by the sixth week. Visual acuity improved in all groups, with 83% achieving 6/6–6/12 vision by the sixth week. Conclusion: All four techniques are effective in MSICS. Viscoexpression and irrigating vectis are associated with fewer complications and faster visual recovery, though differences were not statistically significant.