Accumulating scientific data supports MICS advantages, dispels concerns

Paris—Available scientific information provides ample evidence that bimanual microincision cataract surgery (MICS) is safe and effective, but further study is needed to show whether it is better than the coaxial approach, said Randall J. Olson, MD.

"In many ways, bimanual MICS has taken ophthalmology by storm, but before we can accept this as a technique we should do, it is important to examine the potential barriers carefully," said Dr. Olson at the European Society of Cataract and Refractive Surgeons meeting.

Dr. Olson, of the John A. Moran Eye Center, Salt Lake City, reviewed published and in press studies that help to dispel theoretical concerns about wound burn and that demonstrate the efficacy and efficiency of bimanual MICS under all circumstances. He noted there are now four published studies, three performed with in vitro models and one in vivo, that support the conclusion that wound burn is not a significant issue.

"The fact that microincisions always leak, the thermal advantages of pulse and ultrapulse technology, and experience from the field further indicate that wound burn is not a concern differentiating MICS from conventional coaxial surgery," Dr. Olson said.

Discussing efficacy, Dr. Olson cited his own recently published paper and two other larger, earlier series showing that good results can be achieved even when trying to remove very hard cataracts. Anecdotally, bimanual MICS even seems to be advantageous in certain challenging cases, for example, as it offers increased stability during capsulorhexis creation and the opportunity to switch instruments in the incisions when dealing with eyes with sectoral zonular loss.

Other claims suggest MICS may be safer in terms of reducing or eliminating risks of capsular breakage, endothelial cell loss, incision-related expulsive hemorrhage, and retinal detachment.

"These have potential validity, but the support remains anecdotal, and it is up to the proponents of MICS to carry out good studies and get them into the peer-reviewed literature to provide objective support for these advantages," Dr. Olson said.