Transcript 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
• To evaluate the safety, the feasibility 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
Materials & Methods
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48 eyes
1.8 mm S-MICS on steep axis
Topical anesthesia
Hydrophilic acrylic IOL
Wound assisted injection
ASCRS 09
JL Febbraro MD
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
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
Results
• Keratometric astigmatism
S-MICS n:48
Mean Preop Astig.
Mean Postop Astig
K2-K1
0.59 +/- 0,35 D
0,65 +/- 0,35 D
• Pre and postoperative keratometry
S-MICS n:48
K1
Preop
43,30 +/- 1,43 D
Postop (3 months)
K2
43,28 +/- 1,48 D
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JL Febbraro MD
43,86 +/- 1,48 D
43,90 +/- 1,50 D
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
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
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
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
References
1.
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4.
5.
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