Cost - effectiveness analysis of cataract services in Lagos University Teaching Hospital ( LUTH ) , Lagos , Nigeria

Recently I noticed with surprise, during extracapsular cataract surgery, that cortex was retreating from the anterior port of my simcoe cannula during aspiration, instead of being drawn towards it. On closely examining the cannula, I discovered that the infusion entering the luer connection was plumbed to exit at the anterior port, while the syringe was vigorously aspirating anything near the large side port; iris, anterior capsule, even posterior capsule; certainly not what I was expecting! I discussed this by email with the supplier, who apologised: “I packed Reverse Simcoe in error!” and offered a replacement. I find that the ‘Reverse’ Simcoe is a frequent visitor to extracapsular cataract sets. The surgeon, keen to get in among the cortex, often does not notice he is using one until the outcome of his operation has been affected because the wrong structure has been sucked into the cannula. It is important for the surgeon to recognise the reverse simcoe. This can be done as follows: