Fig. 1.10 Appearance of incision on post-op day 1

uncorrected visual acuity of at least 20/25. There were no intraoperative or postoperative complications. The results of this study confirm the safety and efficacy of combining micro-coaxial phaco with torsional ultrasound. Although this approach is still in its clinical infancy, the rapid acceptance by ophthalmologists around the world suggests that micro-coaxial phacoemulsification with torsional ultrasound is a significant step forward in the evolution of cataract surgery.

Take Home Pearls

ßSmaller incisions in the 2 mm range, which offer astigmatic neutrality, can be achieved with

micro-coaxial phacoemulsification. Excellent fluidics, thermal protection, competent incisions, a minimal learning curve, and implantation of a full size optic without enlarging the incision are some of the benefits of this approach. This procedure can be combined with torsional ultrasound, a new technology that appears to be more safe and efficient with less repulsion and heat production, compared to traditional longitudinal phacoemulsification.

References

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2.Osher RH, Injev VP. Micro-coaxial phacoemulsification. Part 1: laboratory studies. J Cataract Refract Surg 2007; 33:401–407

3.MacKool RJ, Sirota MA. Thermal comparison of the AdvanTec Legacy, Sovereign WhiteStar, and Millennium phacoemulsification systems. J Cataract Refract Surg 2005; 31:812–817

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6.Berdahl JP, DeStafeno JJ, Kim T. Corneal wound architecture and integrity after phacoemulsification; evaluation of coaxial, microincision coaxial, and microincision bimanual techniques. J Cataract Refract Surg 2007; 33:510–515

7.Stratas BA. Clear corneal paracentesis: a case of chronic wound leakage in a patient having bimanual phacoemulsification. J Cataract Refract Surg 2005; 31:1075

8.Weikert MP, Koch DD. Phaco wound study: alterations in corneal wound architecture with bimanual microincisional phacoemulsification. Cataract Refract Surg Today 2005; June:11–13

9.Praveen MR, Vasavada, AR, Gajjar D, Pandita D, Vasavada VA, Vasavada VA, Raj, SM. Comparative quantification of ingress of trypan blue into the anterior chamber after micro-coaxial, standard coaxial, and bimanual phacoemulsification. J Cataract Refrac Surg 2008; 34:1007–1012

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13.Gajjar D, Mamidipudi R, Vasavada A, et al Ingress of bacterial inoculum into the anterior chamber after bimanual and micro-coaxial phacoemulsification in rabbits. J Cataract Refract Surg 2007; 33:2129–2134

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sification Principles and Techniques, 2nd edn. Thorofare, NJ, Slack, 2003; 247–254

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17.Masket S, Belani S. Proper wound construction to prevent short-term ocular hypotony after clear corneal incision cataract surgery. J Cataract Refract Surg 2007; 33:383–386

18.Dosso AA, Cottet L, Burgener ND, Di Nardo S. Outcomes of coaxial microincision cataract surgery versus conventional coaxial cataract surgery. J Cataract Refract Surg 2008; 34:284–288

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1.2 Transitioning to Bimanual MICS

Rosa Braga-Mele

Core Messages

ßTackle an easy case first and remember you can always default back to standard phacoemul-

sification.

ßA clear cornea trapezoidal incision is preferred so as to allow maneuverability within the wound

without stretching.

ßThe capsulorhexis forceps are advantageous as they create very little, if any, pressure on

the incision, but require a slight change in technique.

ßThere are multiple irrigating second instruments available. Try a few before committing

to any one.

ßMost of the currently available phaco platforms will support bimanual MICS without the

need to change current techniques.

1.2.1 Introduction

Microsurgery for phacoemulsification represents the next evolution in techniques for cataract surgery. When bimanual microsurgery was first introduced, the rally behind the push was that surgeons needed to learn smaller incision technique because IOLs that could be inserted into sub-2-mm incisions were on the horizon. Today, many small incision IOL’s are available around the world and the procedure is a reality. The procedure uses separate irrigation instruments and a sleeveless phaco tip to remove cataracts. Irrigation during phacoemulsification is provided through an irrigating chopper or manipulator instead of through the phacoemulsification handpiece. The surgery can be performed through incisions less than 1 mm and is associated with improved maneuverability, visualization, and less refractive error after surgery. Over the

R. Braga-Mele

University of Toronto, Toronto, ON, Canada

e-mail: RHOsher@CincinnatiEye.com