I read J Fumpa’s letter in the Journal (J Comm Eye Health; 2001; 14: 15). His concern is fully understood by those who have lived in such circumstances in the past.
Between ICCE and ECCE (phaco is also ECCE), there exists another system which is suitable to any part of the world and any economic situation. I developed the mini-nuc technique. With a very small number of instruments one can achieve safe and very high standard cataract surgery, with or without an IOL. If a YAG instrument is not available, after implanting the IOL one can perform posterior capsulotomy under the IOL, thus avoiding the necessity of future YAG treatment. As it would be performed under the IOL, the IOL would prevent vitreous prolapse to the anterior chamber.
There are the means to perform perfect cataract surgery around the globe – safely, no viscoelastic material, no sutures, very cost effective. The only thing to be done is to learn how to do it!
1 Blumenthal M, Assia E, Moisseieve Y. Manual ECCE, the present state of the art. Asia-Pacific Journal of Ophthalmology 1995; 4: 21-24.
2 Blumenthal M. “The modern manual small incision extracapsular with mini-nuc technique”. Highlights of Ophthalmology. Volume 28, No 1 ‘2000 series’.