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Microincision Cataract Surgery with a Scleral Approach

Microincision Cataract Surgery with a Scleral Approach. Jean Luc Febbraro MD Marlene Ostendorff MD Damien Gatinel MD Rothschild Foundation Paris France. No financial interest. Purpose.

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Microincision Cataract Surgery with a Scleral Approach

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  1. Microincision Cataract Surgery with a Scleral Approach Jean Luc Febbraro MD Marlene Ostendorff MD Damien Gatinel MD Rothschild Foundation Paris France No financial interest

  2. Purpose • To evaluate thesafety, thefeasibility and the effectiveness of scleral microincision cataract surgery (S-MICS). •  Why S-MICS? • To improve the wound integrity and safety of microincision: scleral incisions heal faster than corneal incision. (Ernest and Neuhann) 1,2,3 ASCRS 09 JL Febbraro MD

  3. Materials & Methods • 48 eyes • 1.8 mm S-MICS on steep axis • Topical anesthesia • Hydrophilic acrylic IOL • Wound assisted injection ASCRS 09 JL Febbraro MD

  4. Materials & Methods S-MICS • Location • 1.5 to 2 mm behind the limbus • Conjunctival miniperitomy (>2mm) • Two plane square incision • Size • 1,8 x 1,8 mm • Scleral tunnel • Knife • Trapezoidal 1.6 X 1.8 mm metal blade ASCRS 09 JL Febbraro MD

  5. Results • Efficiency • Limited intraoperative bleeding (small conjunctival and scleral incisions) • Low incidence of chemosis (2 cases) • Self sealing in most cases (wound hydration in 4 cases) • No postoperative leakage or hyphema • Fast visual recovery: 75% > 20/40 by 3 days po. ASCRS 09 JL Febbraro MD

  6. Results • Keratometric astigmatism • Pre and postoperative keratometry ASCRS 09 JL Febbraro MD

  7. Discussion • Sub 2-mm microincision cataract surgery has proven to be effective and is gaining popularity worldwide.4,5 • Sub 2-mm corneal incisions are not necessarily more stable. • Wound architecture errors, intraoperative stretching and ovalisation of clear corneal MICS may compromise wound self sealing and healing properties. ASCRS 09 JL Febbraro MD

  8. Discussion • In the 1990s Ernest cadavers and animal eyes studies have shown that 3 key parameters could influence wound construction 1,2,3: • Geometry: square incisions provide better stability, regardless of location. • Tissue properties: elastin enables tissue to return to original configuration when stretched. • Histology: fibroblasts speed wound healing. ASCRS 09 JL Febbraro MD

  9. Discussion • Clear corneal MICS is efficient but wound stretching or ovalisation may occur in spite of appropriate incision construction. • Scleral MICS has the following advantages: • Allows for a 1.8 x 1.8-mm square scleral tunnel, more resistant to intraoperative stretching. • Optimum location with ideal tissue and histological properties to optimise self sealing and speed wound healing. • More flexible and forgiving in wound construction errors, enlargement or IOL exchange. ASCRS 09 JL Febbraro MD

  10. Conclusion • The scleral approach for microincision cataract surgery (S-MICS) is an efficient and safe alternative to clear corneal microincision. • It provides satisfactory self sealing and healing properties with very limited cons (bleeding and chemosis). • It provides flexibility in case of wound extension, IOL exchange and forgives wound architecture errors. ASCRS 09 JL Febbraro MD

  11. References • Ernest P.H., Lavery K.T., Kiessling L.A. Relative Strength of Scleral Corneal Incisions Constructed in Cadavers Eyes. J Cataract Refract Surg. 1994;20:84-88 • Ernest P.H., Neuhann T. Posterior Limbal Incision. J Cataract Refract Surg. 1996;22:78-84 • Ernest P.H. et al. Is There a Difference in Incision Healing Based on Location? J Cataract Refract Surg. 1998;24:482-486 • Alio JL et al. Outcomes of Microincision Cataract Surgery Versus Coaxial Phacoemulsification. Ophthalmology. 2005;112:1997-2003 • Alio JL et al. Visual Outcomes of Microincision Cataract with Implantation of Acry Smart Lens. J Cataract Refract Surg. 2005;31:1549-1556 ASCRS 09 JL Febbraro MD

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