Microcoaxial%20phaco%20using%201.8mm%20incisions:%20comparison%20of%20two%20machines%20and%20IOL%20systems

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Microcoaxial phaco using 1.8mm incisionscomparis
on of two machines and IOL systems
Richard Packard Windsor England Consultant for
Alcon, AMO and Bausch and Lomb
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Reasons for making incisions smaller

• Less leakage and therefore better controlled
  surgery
• Minimal if any induced astigmatism
• Faster rehabilitation visually for the patient
• Safer more rapidly healing wounds
• Because we can!

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3.2mm 2.5mm 2.2mm 1.8mm
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Microincisions with coaxial give

• Protected wounds due to sleeve
• Less changes in technique and equipment than
  B-MICS
• Ability to use established IOL technology
• Minimal astigmatism

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What do we need for C-MICS

• Wounds and therefore knives that match
  instrumentation
• Microsurgical capsulorhexis forceps
• New sleeves that are thin and allow enough fluid
  passage
• Thinner phaco tips?
• Understanding hydrodissection with microincisions
• No change in cataract removal techniques
• Phaco machines with appropriate power modulation
  and excellent fluidics
• IOLs capable of being injected with wound
  assistance through unopened Co-MICS incisions

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Incisions for 1.8mm C-MICS
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Capsulorhexis and hydrosteps and tip insertion
for 1.8mm C-MICS
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Stellaris System Overview

• EQ Fluidics equalises fluidic dynamics for solid
  chamber stability in vacuum or flow modes
• Ergonomic six crystal handpiece and tubing for
  efficient cutting and smooth removal of the
  nucleus in all techniques
• CustomControl Software II for customisable power
  modulation for all cataract grades
• Wireless Dual Linear foot pedal for instantaneous
  surgeon control of aspiration and ultrasound
• Sleek and ergonomically designed for operating
  room efficiency
• Modular design customisable to both EQ Fluidics
  options, the Advanced Flow Module or Vacuum
  Fluidics Module, plus all future upgrades

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Stellaris EQ Fluidics Management Technology
EQualising aspiration and irrigation for
unsurpassed safety, efficiency and predictability
in either flow or vacuum modes for solid chamber
stability throughout the procedure
EQ Advanced Flow Module (AFM)
EQ Vacuum Fluidics Module (VFM)
Single module allows surgeons to toggle
intra-operatively between flow and vacuum modes
flow for sculpting, vacuum for capsule polishing
and I/A
Latest generation vacuum fluidics with
StableChamber tubing delivers exceptional
accuracy and efficiency for MICS
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INFINITITM Vision System

• Tri-modal
• AquaLaseTM
• OzilTM
• Improved Traditional Ultrasound
• Fluidics
• User Interface
• Ergonomics

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Fluidic Management System

• Pump roller interface
• Vent valve interface
• Irrigation pinch valve
• Infusion pressure membrane
• Vacuum Pressure Sensor
• IntrepidTM low compression tubing

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MICS tip and sleeve for 1.8mm surgery with B and
L Stellaris

• Straight MICS tip
• 30 degree bevel
• 0.9mm at widest
• 0.5mm internal diameter

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Mini-flared tip and Nano sleeve for 1.8mm surgery
with Alcon Infiniti

• Curved 45 degree mini-flared tip
• 0.9mm at widest
• 0.57mm internal diameter

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Stellaris Handpiece -efficient cutting

• Increased stroke length for efficient cutting of
  the nucleus
• Tighter, more focused and consistent delivery of
  stroke
• CustomControl II Software for customisable,
  programmable wavefront power modulations for all
  techniques

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OzilTM technology
Torsional (side) stroke at tip end (action)
-oscillations occur at tip/hub/horn junction
-distal end of Kelman tip exhibits a side to
side displacement due to tip
geometry More Efficient Cutting with 32KHz
Torsional induces (shearing stress )
vs. Longitudinal u/s
(compression stress) Longitudinal cuts on the
forward stroke Torsional cuts both right or
left efficiency
Translates about 1/3 of thermal dissipation
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Now that we have removed the nucleus which IOL
can we use?
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Akreos Microincision LensOptimised for MICS

• Akreos Microincision Lens Akreos MI60
• Implantable through a 1.8 mm incision using a
  wound-assisted injection
• Biocompatible hydrophilic material with a proven
  record of safety, used in 2 million implantations
  since its introduction in 1998
• The innovative haptic design ensures excellent
  3-Dimensional stability of the IOL

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AcrySof IQ Aspheric Natural IOL(Alcon model
SN60WF)

• Thinner aspheric optic design for 1.8mm insertion
  with wound assistance and D-cartridge
• Blue Light-Filtration
• AcrySof Single-Piece Platform
• Low PCO
• Material with 17years track record

IQ (Image Quality)
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So how do they really compare?

• Both deliver 1.8mm surgery with early visual
  rehabilitation due to no induced astigmatism
• Both require specific knives, capsulorhexis
  forceps, phaco tips and sleeves
• Wound assisted insertion is mandatory
• Time will tell how the IOLs perform in the long
  term as far as PCO is concerned

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Thank you