Coaxial microphaco a major step forward in cataract surgery evolution

Lisbon, Portugal - Coaxial microphacoemulsification performed through a 2.2-mm incision is a new technique that can be readily learned by cataract surgeons skilled in phacoemulsification. The technique affords patients the combined benefits of ultra-small incision surgery and conventional foldable IOLs, Robert H. Osher, MD, said Monday at the European Society of Cataract and Refractive Surgeons meeting.

The coaxial microphacoemulsification procedure has been made possible by the availability of a new ultrasound sleeve (Ultra Sleeve, Alcon Laboratories) that is used with the Infiniti phaco system and the Infiniti flare tip (Alcon Laboratories). The new small diameter sleeve permits surgery using high flow rates and vacuum levels to enable chamber maintenance and protect against thermal and mechanical injury while allowing efficient emulsification of the nuclear material.

With a new technique for IOL implantation and using a plunger-type injector (available from ASICO or Duckworth and Kent), Dr. Osher has been able to implant a currently available 6-mm, single piece acrylic IOL (AcrySof SN60WF or ReSTOR, Alcon Laboratories) through the 2.2-mm incision without enlarging it. Dr. Osher is professor of ophthalmology, University of Cincinnati College of Medicine, and medical director emeritus, Cincinnati Eye Institute, Cincinnati, OH, United States.

He has established that coaxial microphacoemulsification is associated with superior fluidics compared with bimanual microincision surgery in carefully designed laboratory studies. Dr. Osher reported that his clinical experience, which includes more than 100 patients, confirms that the innovative technique can be performed safely and efficiently to remove cataracts of all grades while achieving outcomes matching those seen after conventional coaxial phacoemulsification.

“I believe coaxial microphacoemulsification represents the next major step in the evolution of cataract surgery,” Dr. Osher said. “Surgeons accustomed to performing coaxial phacoemulsification can easily transition to this procedure using the same fluidics to maintain a safe intraocular environment and can implant a conventional foldable IOL through a smaller incision than ever before.

“My patients and I have been enormously satisfied with the outcomes of this procedure, and I anticipate that its attractive features and freedom from a difficult learning curve will lead to its rapid, widespread adoption among cataract surgeons worldwide,” Dr. Osher added.