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

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 sealability 4 Reduce endothelial cell loss 5 1. Heg Wee Jin. WOC 2008, Hong Kong. 2. Braga-Mele R. ASCRS in San Francisco, CA, April, 2009.

3. Barrett GD. APAO Congress. Bali, Indonesia, May, 2009.

4. Barrett GD, Carlsson A. Canadian Ophthalmological Society, Montreal, Canada, June, 2007. 5. Zafirakis P. ASCRS in San Francisco, CA, April, 2009.

Complete MICS System

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

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

1.8 mm C-MICS (22 gauge) 2.8 mm SICS (19 gauge)

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 5

Study

       Retrospective chart review All procedures by same surgeon in same OR Millenium small incision cataract surgery (SICS) 2.8 mm (n=45)  Eyes implanted with SofPort AO or Crystalens IOL Stellaris 1.8 mm MICS (n=63)  Eyes implanted with Akreos MICS IOL EPT, cataract density assessed perioperatively Flare/cells assessed 3.5-5.0 hours postop  Trace=0.5, 1=1.0, 1+-1.5, 2=2.0, 2+=2.5

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

Results

Cataract Density EPT Cells/Flare SICS 2.12

3.9

1.78

MICS 2.15

4 1.26

P-value 0.7745

0.7851

0.0001

Mean Distance Visual Acuity

3M UCVA

2.8 mm SICS 1.8 mm MICS 20/34 20/27

3M BCVA

20/25 20/21

6M UCVA

20/26

6M BCVA

20/24 20/25 20/21

3 Month Distance Visual Acuity

6 Month Distance Visual Acuity

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