- •Preface
- •Contributors
- •Contents
- •Introduction
- •Literature Review
- •Major Issues
- •Major Studies
- •Negative Studies
- •References
- •1.1.1 Introduction
- •1.1.3 Torsional Ultrasound
- •1.1.4 Our Procedure for Emulsifying the Nucleus
- •References
- •1.2 Transitioning to Bimanual MICS
- •1.2.1 Introduction
- •1.2.2 Technique
- •1.2.3 Summary
- •1.3 0.7 mm Microincision Cataract Surgery
- •1.3.1 Sub 1 mm MICS: Why?
- •1.3.3 Instrumentation
- •1.3.3.2 0.7 mm Irrigating Instruments
- •1.3.4 Surgery
- •1.3.4.1 Incision
- •1.3.4.2 Capsulorhexis
- •1.3.4.3 Hydrodissection
- •1.3.4.4 Prechopping
- •1.3.5 0.7 mm MICS Combined Procedures
- •1.3.5.1 0.7 mm MICS and Glaucoma Surgery
- •1.3.6 Summary
- •References
- •2. MICS Instrumentation
- •2.1 MICS Instrument Choice: The First Step in the Transition
- •2.2 MICS Incision
- •2.3 MICS Capsulorhexis
- •2.4 MICS Prechopping
- •2.5 MICS Irrigation/Aspiration Instruments
- •2.5.1 19 G Instruments
- •2.5.2 21 G Instruments
- •2.6 MICS Auxiliary Instrument
- •2.6.1 Scissors
- •2.6.2 Gas Forced Infusion
- •2.6.3 Surge Prevention
- •2.7 New MICS Instruments
- •2.7.1 Flat Instruments
- •References
- •3.1 Introduction
- •3.2 Power Generation
- •3.3.1 Tuning
- •3.2.2 Phaco Energy
- •3.2.2.1 Low Frequency Energy
- •3.2.2.2 High Frequency Energy
- •3.2.3 Transient Cavitation
- •3.2.4 Sustained Cavitation
- •3.3.1 Alteration of Stroke Length
- •3.3.2 Alteration of Duration
- •3.3.2.1 Burst Mode
- •3.3.2.2 Pulse Mode
- •Micro Pulse (Hyper-Pulse)
- •Pulse Shaping
- •3.3.3 Alteration of Emission
- •3.4 Fluidics
- •3.5 Vacuum Sources
- •3.6 Surge
- •3.7.1 Micro-incisional Phaco
- •3.7.2 Bimanual Micro-Incisional Phaco
- •3.7.3 Micro-Incisional Coaxial Phaco
- •3.7.3.1 Irrigation and Aspiration
- •3.8 Conclusion
- •Reference
- •Further Reading
- •4.1 Introduction
- •4.3 Incision Size
- •4.4 Torsional Ultrasound
- •4.5 Conclusion
- •References
- •5. Technology Available
- •5.1 How to Better Use Fluidics with MICS
- •5.1.1 Physical Considerations
- •5.1.1.2 Chamber Stability
- •5.1.1.3 Holdability
- •5.1.2 Surgical Considerations
- •5.1.2.2 Phaco Technique
- •5.1.2.4 The OS3 and CataRhex SwissTech Platforms
- •Equipment
- •Machine Settings
- •5.2 How to Use Power Modulation in MICS
- •5.2.1 Introduction
- •5.2.3 The Concept of Unoccluded Flow Vacuum
- •5.2.4 The Intricacies of Ultrasound Power Modulation
- •5.2.5 The Variable Incidence of Wound Burn Rates
- •References
- •5.3 MICS with Different Platforms
- •5.3.1 MICS with the Accurus Surgical System
- •5.3.1.1 Introduction and Historic Background
- •5.3.1.3 Surgical Parameters for MICS with Accurus
- •5.3.1.4 Final Considerations
- •5.3.2.1 Introduction
- •5.3.2.7 Technology for MICS on the AMO Signature
- •5.3.2.8 Applying Signature Technology to CMICS and BMICS
- •5.3.3 MICS with Different Platforms: Stellaris Vision Enhancement System
- •5.3.3.2 Evaluating the Stellaris Vision Enhancement System
- •5.3.3.3 The Advantages of BMICS
- •References
- •6.1 Pupil Dilation and Preoperative Preparation
- •6.1.1 Managing the Small Pupil
- •6.1.2 Techniques that Depend on the Manipulation of the Pupil
- •6.1.3 Iris Surgery
- •6.1.4 Preoperative Preparation and Infection Prophylaxis
- •6.1.5 Evaluating Risk
- •6.1.6 Assessing Your Approach
- •6.1.7 Preventing Infection, Step by Step
- •6.1.8 Sample Protocol Outline
- •6.1.9 A Careful, Critical Eye
- •References
- •6.2 Incisions
- •References
- •6.3 Thermodynamics
- •6.3.1 Introduction
- •6.3.2 Corneal Thermal Damage
- •6.3.3 Heat Generation
- •6.3.4 Factors that Contribute to Thermal Incision Damage
- •6.3.4.1 Energy Emission: Amount and Pattern of How the Energy Is Delivered
- •6.3.4.3 Viscoelastic Devices and Possible Occlusion of the Aspiration Line
- •6.3.4.4 Irrigation Flow
- •6.3.4.5 Position of the Tip Inside the Incision
- •6.3.4.6 Tip Design
- •6.3.4.7 Surgical Technique
- •6.3.5 Conclusion
- •6.4 Using Ophthalmic Viscosurgical Devices with Smaller Incisions
- •6.4.1 Introduction
- •6.4.1.1 The Nature of OVDs: Rheology
- •6.4.1.3 Soft Shell and Ultimate Soft Shell Technique (SST & USST)
- •6.4.2 Routine, Special and complicated Cases
- •6.4.2.1 Phakic and Anterior Chamber IOLs
- •6.4.2.3 Fuchs’ Endothelial Dystrophy
- •6.4.2.5 Capsular Staining for White & Black Cataracts
- •6.4.2.6 Flomax® Intraoperative Floppy Iris Syndrome USST
- •6.4.3 Discussion
- •References
- •6.5 Capsulorhexis
- •References
- •References
- •6.7 Biaxial Microincision Cataract Surgery: Techniques and Sample Surgical Parameters
- •6.8.1 Surgical Technique
- •6.8.2 Advantages
- •6.8.3 Disadvantages
- •6.8.4 Final Thoughts
- •References
- •6.9 BiMICS vs. CoMICS: Our Actual Technique (Bimanual Micro Cataract Surgery vs. Coaxial Micro Cataract Surgery)
- •6.9.1 Introduction
- •6.9.2 Historical Background
- •6.9.3 BiMICS. BiManual MicroIncision Cataract Surgery
- •6.9.3.1 Introduction
- •6.9.3.2 Instrumentation
- •6.9.3.5 Phacotips
- •6.9.3.6 Capsulorhexis
- •6.9.3.7 Phaco Knives
- •6.9.3.8 The Phaco Machines
- •6.9.3.9 Phaco Pumps
- •6.9.3.10 Ultrasound Power Delivery
- •6.9.3.11 IOL Implantation
- •6.9.3.12 Astigmatism
- •6.9.4.1 Capsulorhexis
- •6.9.4.2 Phacotips
- •6.9.4.3 The Phaco Machines
- •6.9.4.4 Phaco Pumps
- •6.9.4.5 Ultrasound Power Delivery
- •6.9.4.6 Irrigation-Aspiration
- •6.9.4.7 Incision-Assisted IOL Implantation
- •6.9.5 Conclusion
- •References
- •6.10 Endophthalmitis Prevention
- •6.10.1 Antibiotic Prophylaxis
- •6.10.2 Wound Construction
- •6.10.3 Summary
- •References
- •7.1 High Myopia
- •7.2 Posterior Polar Cataract
- •7.3 Posterior Subluxed Cataracts
- •7.4 Mature Cataract with Zonular Dialysis
- •7.5 Punctured Posterior Capsule
- •7.6 Posterior Capsule Rupture
- •7.7 Pseudoexfoliation
- •7.8 Rock-Hard Nuclei
- •7.9 Switching Hands
- •7.10 Microcornea or Microphthalmos
- •7.11 Large Iridodialysis and Zonular Defects
- •7.12 Intraoperative Floppy Iris Syndrome (IFIS)
- •7.14 Iris Bombé
- •7.15 Very Shallow Anterior Chambers
- •7.16 Refractive Lens Exchange
- •7.18 Intraocular Cautery
- •7.19 Biaxial Microincision Instruments
- •References
- •7.1 MICS in Special Cases: Incomplete Capsulorhexis
- •7.1.1 Introduction
- •7.1.2 Avoiding Complications While Constructing Your Microcapsulorhexis
- •7.1.3 Avoiding Complications During Biaxial Phaco with an Incomplete Capsulorhexis
- •7.1.4 Avoiding Complications During IOL Insertion with an Incomplete Capsulorhexis
- •7.1.5 Conclusions
- •References
- •7.2 MICS in Special Cases (on CD): Vitreous Loss
- •7.2.1 Introduction
- •7.2.2 Posterior Capsule Tears and Vitreous Prolapse
- •7.2.3 Vitreous and the Epinucleus or Cortex
- •7.2.4 Different Techniques Other than Pars Plana Vitrectomy for Nuclear Loss in Vitreous
- •7.2.5 Pars Plana Vitrectomy
- •7.2.6 Zonulolysis
- •References
- •7.3 How to Deal with Very Hard and Intumescent Cataracts
- •7.3.1 Introduction
- •7.3.2 Types of Cataracts
- •7.3.3 Management of Hard Cataracts Through Biaxial Technique
- •7.3.4 Incision
- •7.3.5 Capsulorrhexis
- •7.3.6 Hydrodissection
- •7.3.8 Conclusion
- •References
- •8. IOL Types and Implantation Techniques
- •8.1 MICS Intraocular Lenses
- •8.1.1 Introduction
- •8.1.2 Lenses
- •8.1.2.2 ThinOptX MICS IOLs (ThinOptX, Abingdon, VA)
- •8.1.2.3 Akreos MI60 AO Micro Incision IOL (Bausch & Lomb, Rochester, NY)
- •8.1.2.4 IOLtech MICS lens (IOLtech, La Rochelle, France; and Carl Zeiss Meditec, Stuttgard, Germany)
- •8.1.3 Optical Quality of MICS IOLs
- •8.1.4 Conclusion
- •References
- •8.2 Implantation Techniques
- •8.2.2 Prerequisites to a Sub-2 Injection
- •8.2.3 IOLs Used for Injection Through Microincision
- •8.2.3.1 Material
- •8.2.3.2 Design
- •8.2.3.3 Optic Design
- •8.2.3.4 Haptic Design
- •8.2.3.5 Posterior Barrier (360°)
- •8.2.4 Injectors Meant for Microincision
- •8.2.4.1 Objectives of Injectors Meant for Microincision
- •8.2.4.2 Characteristics of Sub-2 Injectors
- •8.2.4.3 The Cartridges
- •Loading Chambers
- •Injection Tunnels and Cartridge Tips
- •8.2.4.4 The Plunger Tips (or plunger)
- •8.2.4.5 Pushing Systems
- •8.2.4.6 Injector Bodies
- •8.2.4.7 Principal Sub-2 Injectors
- •8.2.5 Visco Elastic Substances and Injection Through Microincision
- •8.2.6 Techniques of Sub-2 Injection
- •8.2.6.2 Incision Construction
- •8.2.6.3 Pressurization of the Anterior Chamber
- •8.2.6.4 Loading the Cartridge
- •8.2.6.5 Loading the Injector
- •8.2.6.6 Insertion of the Plunger Tip
- •8.2.6.7 Injection in the Anterior Chamber
- •8.2.6.8 Positioning the IOL in the Capsular Bag
- •8.2.6.9 Removing the VES
- •8.2.6.10 Thin Roller Injector
- •8.2.6.11 Conclusion
- •Reference
- •8.3 Special Lenses
- •8.3.1 Toric Posterior Chamber Intraocular Lenses in Cataract Surgery and Refractive Lens Exchange
- •8.3.1.1 Introduction
- •8.3.1.3 T-IOL Calculation
- •8.3.1.4 Current T-IOL Models
- •8.3.1.5 Preoperative Marking
- •8.3.1.6 Clinical Indications
- •8.3.1.7 Custom-Made Lenses
- •8.3.1.8 Conclusion for Practice
- •References
- •8.3.2 Special Lenses: MF
- •8.3.2.1 Discussion
- •8.3.2.2 Conclusion
- •8.3.2.3 Outlook
- •References
- •8.3.3 Special Lenses: Aspheric
- •References
- •8.3.4 Intraocular Lenses to Restore and Preserve Vision Following Cataract Surgery
- •8.3.4.1 Introduction
- •8.3.4.2 Why Filter Blue Light?
- •Summary
- •8.3.4.3 Importance of Blue Light to Cataract and Refractive Lens Exchange Patients
- •Summary
- •8.3.4.4 Quality of Vision with Blue Light Filtering IOLs
- •Summary
- •8.3.4.5 Clinical Experience
- •Summary
- •8.3.4.6 Unresolved Issues and Future Considerations
- •References
- •8.3.5 Microincision Intraocular Lenses: Others
- •8.3.5.1 ThinOptX®
- •8.3.5.2 Smart IOL
- •8.3.5.4 AcriTec
- •8.3.5.5 Akreos
- •8.3.5.7 Rayner
- •8.3.5.8 Injectable Polymers
- •8.3.5.9 Final Comments
- •References
- •9. Outcomes
- •9.1 Safety: MICS versus Coaxial Phaco
- •9.1.1 Introduction
- •9.1.2 Visual Outcomes
- •9.1.3 Incision Damage
- •9.1.4 Corneal Incision Burn
- •9.1.5 Corneal Changes
- •9.1.6 Infection
- •9.1.7 Summary
- •References
- •9.2 Control of Corneal Astigmatism and Aberrations
- •9.2.1 Introduction: Impacts of MICS Incision on the Outcomes of Cataract Surgery
- •9.2.2 Objective Evaluation of Corneal Incision
- •9.2.3 Control of Corneal Aberration and Astigmatism with MICS
- •9.2.4 Role of Corneal Aberrometry in Evaluating MICS Incision
- •9.2.5 Role of OCT in Evaluating MICS Incision
- •9.2.6 Our Experience in Corneal Aberrations and Astigmatism After MICS
- •9.2.7 Conclusion
- •References
- •9.3 Corneal Endothelium and Other Safety Issues
- •9.4 Incision Quality in MICS
- •9.4.1 Introduction: History of Incision Size Reduction
- •9.4.2 The Trends Towards Microincision Cataract Surgery (BMICS)
- •9.4.3 Advantages of Minimizing the Incision Size
- •9.4.4 Model for the Analysis of Corneal Incision Quality [21]
- •9.4.5 Our Protocol for Evaluation of Incision Quality in BMICS [21]
- •9.4.6 Results
- •9.4.6.1 Visual, Refractive and Biomicroscopic Outcomes
- •9.4.6.2 Incision Imaging (OCT) Outcomes
- •9.4.8 Conclusion
- •References
- •INDEX
9.2 Control of Corneal Astigmatism and Aberrations |
291 |
Take Home Pearls
ß MICS sub-2 mm incision surgery is effective in stabilizing the corneal optics after surgery.
ßMICS surgery technique compared to standard coaxial phacoemulsification diminishes surgi-
cally induced astigmatism.
ßWith MICS, we can achieve a reduction of astigmatism and higher-order corneal aber-
rations.
ßOCT is a very useful tool in assessing corneal incision quality in MICS.
ßCorneal OCT provides a standardized model and protocol to objectively evaluate incision
quality in MICS.
ßCorneal OCT concluded that MICS incision has an excellent morphological and optical
behaviour in shortand long-term outcomes.
References
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