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

Coaxial Microincision Cataract Surgery Coaxial Microincision Cataract Surgery (MICS)(MICS)

The trend in cataract surgery is toward smaller incisions

Coaxial MICS (C-MICS)Use current phaco techniqueReduce surgically induced astigmatism (SIA)1-3

Increase wound sealability4 Reduce endothelial cell loss5

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 SystemComplete 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)

5

Akreos MICS IOLAkreos MICS IOL

Akreos MICS lens inserts through 1.8 mm phaco incision30% thinner than

Akreos AO lens Aspheric aberration-free

optic Moderate refractive index 360° posterior square-edge design

StudyStudy 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

ResultsResults

SICS MICS P-value

Cataract Density

2.12 2.150.7745

EPT 3.9 4 0.7851

Cells/Flare 1.78 1.26 0.0001

Mean Distance Visual Mean Distance Visual AcuityAcuity

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

3 Month Distance Visual Acuity3 Month Distance Visual Acuity

6 Month Distance Visual Acuity6 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 astigmatismImproves wound strength and integrityReduces endothelial cell lossReduce postoperative endophthalmitisReduce patient recovery time