Transcript Safety and Efficacy of Bimanual Microincisional Cataract

Safety and Efficacy of
Bimanual Microincisional Cataract Surgery
Under Anterior Chamber Maintainer
in Senile Cataract Patients
Özcan R. Kayıkçıoğlu, Sinan Emre
Celal Bayar University School of Medicine,
Department of Ophthalmology, Manisa, Turkey
Authors have no financial interest
San Francisco-ASCRS-2009
Introduction:
• Cataract surgery continues evolution
– Technological advances,
– Enhanced surgical techniques
– Smaller incision
• Improved refractive and visual outcomes
• Reduced intra & postoperative complications
San Francisco-ASCRS-2009
Introduction:
• Incision size reduction led to the
development of “microincisional” cataract
surgery (MICS)
• Cataract removal through 1.0–1.5 mm
incisions
• Anterior chamber instability
• Anterior chamber maintainer (ACM) (?)
San Francisco-ASCRS-2009
Purpose:
• To investigate the safety and efficacy of
microincisional cataract surgery (MICS)
combined with anterior chamber
maintainer (ACM)
San Francisco-ASCRS-2009
Patients and Methods:
• 35 eyes of 32 patients with senile cataract
• Phaco with MICS under ACM and implantation
of PC/ IOL
• ACM placed inferotemporally, capsulorhexis was
performed as vacuum capsulorhexis under ACM
• Phaco performed through a 1.8mm incision
– Sleveless Sovereign Whitestar cold phaco
– Irrigating chopper
– ACM
for better anterior chamber stability
San Francisco-ASCRS-2009
Patients and Methods:
• Following bimanual cortical clean up,
corneal incision was enlarged to 3mm and
IOL implanted with an injector under ACM
• Intraoperative complications, BCVA,
biomicroscopy, IOP and fundoscopy,
preoperatively, 1 day, 1week and 1 month
were recorded and reviewed
San Francisco-ASCRS-2009
San Francisco-ASCRS-2009
Results:
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•
•
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17 M (53.2 %) and 15 F (46.8%)
Mean age: 63.8±9.7 (42-83) years
21 /14 : R /L eyes (60% and 40%)
Cataract type:
–
–
–
–
–
–
Nuclear in 18 (51.4%)
PSC in 5 (14.3%)
Nuclear and cortical in 3 (8.6%)
Posterior subcapsular and cortical in 3 (8.6%)
White mature in 3 (8.6%)
Posterior subcapsular and nuclear in 2 (5.7%)
– Posterior polar in 1 (2.8%)
San Francisco-ASCRS-2009
Results:
• Preop. mean VA: 0.18±0.16 ↑ 0.73±0.29 on 1m
• Preoperative mean IOP 14.2±3.5 and 14.1±3.6
mmHg on 1 d
• No early postoperative IOP rise
• Postoperatively 8 (22.9%) patients had corneal
edema which disappeared on 1 m
• No posterior intraoperative posterior capsular
break or vitreous loss, no wound burn
• DR &AMD most frequent retinal problems 28.5%
San Francisco-ASCRS-2009
Discussion:
• ACM:
– Improves anterior chamber stability
– Maintains wound temperatures below the
threshold for thermal injury
– Keeps away the posterior capsule
– Decreased postoperative inflamatory
mediators
– Economy
San Francisco-ASCRS-2009
Conclusion:
• MICS combined with ACM was safe and
efficient in senile cataract patients
San Francisco-ASCRS-2009