Evaluation of a complete 1.8 mm coaxial microincision cataract (C-MICS 1.8) procedure

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Evaluation of a complete 1.8 mm coaxial
microincision cataract (C-MICS 1.8) procedure

• J. E. Jay McDonald, II M.D.
• McDonald Eye Associates
• Fayetteville, Arkansas
• www.mcdonaldeye.com

Financial disclosure Bausch and Lomb
Consultant Addition Technology - Advisory Board
Santen - Research Support Acufocus - Research
Support Alcon Pharmacology - Speaker Bureau
Wave Tec Research Support Inspire
Consultant Revitalvision, Inc. - Advisory Board
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Coaxial Microincision Cataract Surgery (MICS)

• The trend in cataract surgery is toward smaller
  incisions
• Coaxial MICS (C-MICS)
• Use current phaco technique
• Reduce surgically induced astigmatism (SIA)1-3
• Increase wound sealability4
• Reduce endothelial cell loss5

• Heg Wee Jin. WOC 2008, Hong Kong.
• Braga-Mele R. ASCRS in San Francisco, CA, April,
  2009.
• Barrett GD. APAO Congress. Bali, Indonesia, May,
  2009.
• Barrett GD, Carlsson A. Canadian Ophthalmological
  Society, Montreal, Canada, June, 2007.
• Zafirakis P. ASCRS in San Francisco, CA, April,
  2009.

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Complete MICS System

• Stellaris system for 1.8 mm phaco
• Akreos MICS IOL implantable through 1.8 mm
  incision

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Stellaris 1.8 Coaxial MICS

• Only system designed for coaxial 1.8 mm
  microincision cataract surgery (C-MICS)
• Easy transition from small-incision to
  microincision surgery
• StableChamber fluidics enhances followability,
  holdability and chamber stability

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Akreos MICS IOL

• Akreos MICS lens inserts through 1.8 mm phaco
  incision
• 30 thinner than Akreos AO lens
• Aspheric aberration-free optic
• Moderate refractive index
• 360 posterior square-edge design

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Study

• Retrospective chart review
• All procedures by same surgeon in same OR
• Millenium small incision cataract surgery (SICS)
  2.8 mm (n45)
• Eyes implanted with SofPort AO or Crystalens IOL
• Stellaris 1.8 mm MICS (n63)
• Eyes implanted with Akreos MICS IOL
• EPT, cataract density assessed perioperatively
• Flare/cells assessed 3.5-5.0 hours postop
• Trace0.5, 11.0, 1-1.5, 22.0, 22.5
• Uncorrected and best-corrected distance visual
  acuity at 3 and 6 months
• Some eyes targeted for monovision measured
  uncorrected and best-corrected near VA at 3 and 6
  months

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Results
SICS MICS P-value
Cataract Density 2.12 2.15 0.7745
EPT 3.9 4 0.7851
Cells/Flare 1.78 1.26 0.0001
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Mean Distance Visual Acuity
3M UCVA 3M BCVA 6M UCVA 6M BCVA
2.8 mm SICS 20/34 20/25 20/26 20/24
1.8 mm MICS 20/27 20/21 20/25 20/21
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3 Month Distance Visual Acuity
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6 Month Distance Visual Acuity
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Conclusion

• Microincision cataract surgery results in a
  quieter postoperative eye than small incision
  cataract surgery
• Minimizing incision size in cataract surgery may
  also
• Decrease surgically induced astigmatism
• Improves wound strength and integrity
• Reduces endothelial cell loss
• Reduce postoperative endophthalmitis
• Reduce patient recovery time