Background: Manual ECCE has proved to be safe surgery compatible with small incision, no stitches, possible topical anesthesia, very cost effective and quick rehabilitation. The technique has a learning curve and needs experience. "Mini-nuc" stands for mini nucleus. This surgery can be achieved only if performed under positive intraocular pressure (IOP).
Methods: A BSS bottle is connected to the eye by an anterior chamber maintainer (ACM). The height of the BSS bottle controls the IOP during the surgery. Controlled IOP is a principle suggested for all kinds of cataract surgery. It creates continuous flow which washes out of the eye cortex debris, blood, pigment, etc. The BSS contains antibiotics and adrenalin, it creates low turbulence due to the small amount of BSS used per case, 30-50 cc. A round capsulorhexis is essential. A special way of hydrodissection creates a very small hard core nucleus delivered to the anterior chamber and is extracted out through a sclero-corneal tunnel using a glide introduced under the nucleus to guide the nucleus out.
Results: Positive IOP during all stages of surgery creates the best operative conditions for controlled surgery throughout all manipulations. This technique is a very cost effective system and at the same time provides a high quality procedure.