MICS has benefits for surgeon and patient, says speaker

Key Points

New Orleans-Because microincisional cataract surgery (MICS) permits the use of smaller incisions than those employed in conventional phacoemulsification, it is potentially a safer procedure, offering greater control to the surgeon; also, it may yield less astigmatism, less inflammation, and quicker healing for the patient, said Louis D. "Skip" Nichamin, MD, at the annual meeting of the American Academy of Ophthalmology.

"I do believe that MICS in some form is something that we all really ought to be very excited about," Dr. Nichamin, medical director of the Laurel Eye Clinic, Brookville, PA, told attendees.

All of the major phaco platforms soon will be facilitating incisions in the 2-mm range, he added. "Microincisional IOL implants are a reality and are going to be here soon," Dr. Nichamin said, so a surgeon will not need to enlarge an incision to accommodate IOL insertion.

"Obviously, safety is going to be paramount, and ease by which we can adopt these techniques," Dr. Nichamin said. "We're certainly not going to surrender any control over the intraocular milieu for these smaller incisions, nor am I personally willing to allow efficiency to suffer." Additional considerations include cost and visual outcomes, he said, noting that more data are needed regarding the latter issue.

Smaller incisions

"At this juncture, what can we say about MICS? What does it bring to the table?" Dr. Nichamin asked rhetorically. "Obviously, smaller incisions. And I know we always have the argument of diminishing returns, but I would submit to you that smaller is always better. We have an unmitigated desire to achieve smaller incisions, because smaller is safer. Specifically, it's easier to create an incision that is as deep as it is wide.

"Smaller wounds also ought to lend more control, but that means they have to be watertight and not distorted and leaky," he added. "Of course, we know a smaller incision yields less astigmatism, and we would expect that less trauma leads to less inflammation and quicker healing" than that seen with the larger incisions used in conventional phaco.

Clear corneal incisions have been associated with a greater incidence of endophthalmitis than that seen with sclerocorneal tunnel incisions, said Dr. Nichamin, referencing a white paper released by the American Society of Cataract and Refractive Surgery's Cataract Clinical Committee (J Cataract Refract Surg. 2006;32:1556-1559). "We acknowledge that this was a multifactorial, complex problem, but at the root of the story is the fact that clear corneal incisions are less forgiving. They're harder to create. So with MICS, we can have a smaller incision that we can make in a way that is more square, as Paul Ernest has advocated, and that's a good thing."