Intraocular lens dialing in manual small-incision cataract surgery: Understanding mechanics with a jam bottle lid analogy

ABSTRACT

Manual small-incision cataract surgery (MSICS) has evolved into a widely performed procedure since its introduction in the 1980s, particularly in developing countries, owing to its cost-effectiveness and outcomes comparable to phacoemulsification. Among the critical steps in MSICS, intraocular lens (IOL) dialing remains challenging, especially for beginners. Although literature exists, there is limited emphasis on the underlying mechanics required for smooth and effective in-the-bag implantation of a Polymethyl methacrylate (PMMA) IOL using lens-holding forceps and a Sinskey hook. Structured conceptual frameworks explaining the vector dynamics and biomechanical principles of IOL dialing are lacking. This video proposes an analogy-based instructional model aimed at improving intraoperative spatial understanding among trainees. Such visualization is important to minimize complications, including capsulorrhexis extension, posterior capsular rupture, zonular dehiscence, IOL instability, and haptic damage. This work does not propose a new surgical technique but presents a structured pedagogical framework to enhance understanding of an existing maneuver.