Numb Thumb

It didn’t occur to me until the end of the day on Tuesday.  My left thumb felt numb!  I reviewed the events of the day, trying to put my finger on why this sensation persisted.  Then I realized the answer to my question rested in 5 letters: Simco. 

In the United States, we generally use an ultrasound machine called a phacoemulsifier when performing cataract surgery.  As a resident, this was my bread and butter surgery.  One that I took joy in learning and performing.  It was the standard of care for treating cataracts.  The corneal entry wound was 3 mm or smaller, and the results of this surgery were fantastic.

Enter: Zambia.  Here, the patients are different.  The standard of care is different.  The cataracts are much more advanced and complex.  For cataract surgery, we routinely perform “small incision cataract surgery (SICS).”  This is a manual technique in which a 6 mm self-sealing incision is fashioned in such a way that a suture is not necessary to close the wound.  Instead of an ultrasound probe breaking up the cataract within the eye, the entire lens is milked out in a single piece.  Afterwards, a small “Simco” needle is attached to a lactate ringer’s bag and a 10 cc syringe allowing for aspiration of the remaining cortical lens matter before a new artificial lens is placed in the eye.

During all of residency, I only performed 6 such operations.  And these were done in Bolivia, not in the U.S.  However, I am happy to report that I have already done 8 SICS during the last few days.  I am not yet the fastest surgeon, as there is a bit of a learning curve for this technique. Also, they were not all straightforward cases.  The most typical story went as follows: “50- or 60-something year old farmer from such-and-such village who has been blind in both eyes for a few years, light perceptions or hand motions vision in both eyes, with completely dense white or brunescent cataracts.”  Dozens of these patients had been brought to our eye hospital throughout the week as a special outreach effort through an organization called SightSavers in celebration of World Sight Day. What a blessing it was to partake in helping these poor souls see.  And thank God that all our patients are doing well.  Nonetheless, the aspiration syringe action has taken a toll on my poor left thumb.  It still feels numb.