Jorge L. Alio MD PhD Ma. Cecilia C. Agdeppa MDVISSUM-Instituto Oftalmologico de AlicanteASCRS Convention 2010 Boston

Efficiency of MicroIncision Cataract Surgery using comprehensive MICS

in Different Cataract Densities

Financial DisclosureProf. Jorge L. Alió MD, PhD.

D AcuFocus A-D Akkolens D Alcon Laboratories A-D Bausch&Lomb D Carl Zeiss Meditec D Chemedica A Eyemaginations P Index Instruments D IntraLase Corporation

A MediphacosD Novagali PharmaD-P NulensA Ocular Surgery News/SlacA-D OculentisA PresbiaD-E Schwind eye-tech-solutionP Springer VerlagP TekiaD Thea

Introduction

Rapid evolution of cataract surgery due to development of newer, better, more sophisticated technologies and surgical techniques

Leading the forefront is MICS and phaco systems best suited for microincision surgeries such as the Stellaris Vision Enhancement system

Purpose of the Study

To evaluate the efficiency of microincision cataract surgery (MICS) using the Stellaris Vision Enhancement System in different cataract densities

Study Design and Patients

Non Randomized Descriptive Study 109 eyes of 65 patients All patients underwent MICS using

the Bausch&Lomb Stellaris Phacoemulsification System

Visually significant based on the LOCS scale

Inclusion and Exclusion Criteria

Inclusion Criteria age 40 years to 90 years no history of ocular surgery non-diseased cornea and normal fundus

examination Exclusion Criteria

eyes with more than 3.00 diopters (D) of astigmatism

previous corneal and refractive surgeries those who had history of ocular disease

MICS Steps A dominant incision was made in the positive meridian of the astigmatism

approximately 1.2mm wide internally and 1.4mm externally A sideport incision using the same knife was placed 90o to 110o from the

main incision. Anesthesia was achieved by injecting 1% lidocaine into the anterior chamber. Pupillary dilation was obtained with intracameral mydriatics using

phenylephrine 10.0% and tropicamide 10%. A dispersive ophthalmic viscosurgical device (OVD) was instilled to fill the

anterior chamber Capsulorrhexis of approximately 5.5mm was made using the 23-gauge Alió

MICS Capsulorrhexis Forceps (Katena, Inc) Adequate hydrodissection was done Prechopping was done. Phacoemulsification was achieved using the Stellaris Vision Enhancement

System (Bausch & Lomb).

Stellaris Phacoemulsification System Improvement and innovation in

phacoemulsification technology Advanced Flow Module (EQ Fluidics)

Enhanced followability and aspiration control Minimum post-occlusion surge Rapid return to solid state

Stable Chamber Pack Micro-mesh filter system with reduced

diameter tubing Provides greater holding power at low flow

rates even at higher vacuum levels

Stellaris Phacoemulsification System Custom Control Software II

Permits millisecond range modulation ultrasound control

Variable duty cycle application of 28.5kHz ultrasound for optimized cavitation and rapid emulsification

Ergonomic Design New six-crystal ergonomic handpiece for

optimized cutting and cavitation Bluetooth wireless dual linear foot pedal

Results

Patient Characteristics 109 eyes of 65 patients 42 (65%) females, 23 (35%) males Mean Age 69 years (range 40-93 years)

Results

Results

Mean Vacuum

Phaco Power (%)

APT1 EPT2

LOCS I 381.82±29.93

0.36% 0.0062±0.0077

0

LOCS II 361.2±61.86

1.08% 0.16±0.14 0.003±0.002

LOCS III 356.46±64.65

1.5% 0.30±0.25 0.0071±0.0064

LOCS IV 365.79±66.78

2.21% 0.96±0.81 0.021±0.02

LOCS V 391.67±20.41

3.5% 2.36±1.56 0.067±0.041 APT: Average Phaco Time2 EPT: Effective Phaco Time

Burst Duration: 20 pulses per secondDuty Cycle: 60%

Conclusion

MICS with the Stellaris Vision Enhancement System is possible in all cataract densities with minimal use of phaco power (max 3.5% for grade 5 cataract) and very low phacoemulsification time allowing excellent efficiency of the surgery as manifested by the low EPT found in all cataract groups.