Microincision cataract surgery shaping cataract future

Toronto-Simply stated, coaxial microincision cataract surgery (MICS) is a better phacoemulsification procedure because it delivers better patient outcomes, according to Rosa Braga-Mele, MD.

"It has many benefits that include improved intraoperative control, safety, and efficiency compared with phacoemulsification performed through a larger incision," she said. "Together, these assets translate into better visual outcomes and happier patients."

"All modern phaco platforms have sophisticated fluidics technology that enhances chamber stability and surgical safety," said Dr. Braga-Mele, who is also director of the cataract unit, Mt. Sinai Hospital, Toronto. "However, non-longitudinal ultrasound minimizes energy use, maximizes followability and holdability of nuclear segments, further enhances anterior segment stability, and minimizes risk of trauma to the incision from thermal injury or instrument torqueing.

"In particular, followability is just not as good using longitudinal ultrasound as it is with the non-longitudinal modalities," she said.

Discussing the advantages of the coaxial MICS procedure, Dr. Braga-Mele noted that one of its biggest benefits is that it minimizes the amount of irrigating fluid used. This translates into reduced turbulence in the anterior segment and consequently into less corneal edema, as confirmed by studies Dr. Braga-Mele performed measuring corneal pachymetry.

The microincision also enables early tight incision closure, which theoretically reduces the risk for endophthalmitis, as well as faster wound healing, and, as demonstrated by Samuel Masket, MD, less surgically induced astigmatism (SIA) compared with larger, conventional coaxial cataract surgery incisions. Together with the reduced corneal edema, these benefits account for faster and better visual recovery, Dr. Braga-Mele said.

"Minimizing SIA is particularly important in procedures using a premium IOL, either toric, multifocal, or toric multifocal implants, because it allows for better, more predictable refractive outcomes that are critical for achieving the best vision with these technologies," she said.