High-volume phacoemulsification is difficult in developing countries because the technology requires costly machinery and consumables. Manual small-incision cataract surgery (SICS) is comparable to phacoemulsification in achieving excellent visual outcomes with low complication rates and is significantly faster and less expensive.1"4 The basis of manual SICS is the tunnel construction. By convention, a fornix-based conjunctival flap is considered a requirement.
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