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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 PowerPoint Presentation
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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 - PowerPoint PPT Presentation


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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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slide1

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

methods
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
phaco platform used
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

fluidic control power modulations
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
microincision iol akreos mi60
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
settings used on stellaris afm
Settings Used on Stellaris AFM

For B-MICS BH raised by 10 cm over above settings

slide7

Intraoperative Parameters

Advanced Flow Module – Flow Mode Used (N=40)

intraoperative
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
1 8 mm c mics with mi60 iol insertion
1.8 mm C-MICs with MI60 IOL insertion

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day 1 postoperatively
Day 1 Postoperatively
  • IOL well-centered
  • Subjectively, patients happy with no complaints
month 6 postoperatively
Month 6 Postoperatively
  • No induced astigmatism
  • Good contrast sensitivity
  • IOL well-centered
  • Subjectively, patients happy with no complaints (no edge glare, halos)
summary
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)