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1.8 mm Cataract Surgery: Clinical Results 6 Months after Coaxial and Biaxial MICS and Implantation of a New Micro-incisi

1.8 mm Cataract Surgery: Clinical Results 6 Months after Coaxial and Biaxial MICS and Implantation of a New Micro-incision IOL . Rosa Braga-Mele, M. Ed, M.D., FRCS(S) Associate Professor, University of Toronto, Canada

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1.8 mm Cataract Surgery: Clinical Results 6 Months after Coaxial and Biaxial MICS and Implantation of a New Micro-incisi

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  1. 1.8 mm Cataract Surgery: Clinical Results 6 Months after Coaxial and Biaxial MICS and Implantation of a New Micro-incision IOL Rosa Braga-Mele, M. Ed, M.D., FRCS(S) Associate Professor, University of Toronto, Canada Director of Cataract Unit and Surgical Teaching,Mount Sinai Hospital, Toronto Consultant for B&L, AMO and Alcon

  2. Methods • A Pilot Study was conducted to evaluate the Stellaris Vision Enhancement System and a new microincisional IOL when used to perform phaco in a clinical setting by 1 surgeon • At our center, we performed surgery with: • Biaxial MICS (1.4-1.6 mm incision) and MicroFlow needle • Coaxial MICS (1.8 mm incision) with MICS 1.8 mm needle • All patients • +2 to +4 nuclear sclerotic cataracts • Insertion of the MI60 intraocular lens ( a microincisional IOL delivered through a 1.8-1.9 mm incision) • Both B-MICS and C-MICS surgeries • Stellaris Advanced Flow Module in flow mode was used • Intraoperative, Day 1 and 6 month data were analyzed

  3. Phaco Platform Used • Choice of Pump Systems; Fluidic Options (Vacuum or Flow-based) • 6 Crystal Ultrasound hand piece • Custom Power Modulation • MICS Platform Ready Bimanual and Micro-coaxial techniques • 1.4mm MICS • 1.8 and 2.2mm Coaxial MICS • Wireless Dual Liner Foot Control Stellaris Vision Enhancement System

  4. EQ Fluidics Minimizes surge Highly accurate vacuum measurements Transducer sensitive to extremely small changes in vacuum Non-contact Housed in low compliance material Rapid response software controls pump Avoid rapid influx of fluid from anterior chamber Ultrasound Control Advanced Custom Control Software Extended hyper-pulse and micro-burst modes Pulse shaping increases followability Fluidic control & Power modulations

  5. Microincision IOL (Akreos MI60) • Material is flexible, deformable, resists tearing • Suitable for injection through sub-2 mm incision • Minimize PCO with 4 angulated haptics (10°) and a continuous 360° barrier • Stable in the bag through suitable haptic design

  6. Settings Used on Stellaris AFM For B-MICS BH raised by 10 cm over above settings

  7. Intraoperative Parameters Advanced Flow Module – Flow Mode Used (N=40)

  8. Intraoperative • At end of phaco wound size was re-measured • BMICS 1.5 mm (enlarged to 1.8 for IOL) • CMICS 1.8 mm • MI60 IOL was inserted through 1.8 mm incision with minimal or no difficulty • Gentle insertion, no tissue damage • Easily unfolds into capsular bag • Centres immediately • End of insertion: wound re-measured: 1.9mm in all cases

  9. 1.8 mm C-MICs with MI60 IOL insertion PLEASE CLICK ON VIDEO FILE IF NOT PLAYING HERE. THANK YOU.

  10. Day 1 Postoperatively • IOL well-centered • Subjectively, patients happy with no complaints

  11. Month 6 Postoperatively • No induced astigmatism • Good contrast sensitivity • IOL well-centered • Subjectively, patients happy with no complaints (no edge glare, halos)

  12. Summary • AFM Flow module • Enhances nuclear removal while minimizing required phaco energy and good chamber stability • Similar phaco time and power utilization for both BMICS AND CMICS • Slightly better fluidic control and chamber stability using the 1.8 mm CMICS setup over BMICS • Learning curve short • Specifically for CMICS procedure • Good postoperative outcomes with minimal or no induced astigmatism and good IOL centration with good visual outcomes for patients (using MI60 IOL and 6 mos f/u)

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