Phaco platform, lens may help make coaxial MICS routine

The Stellaris produces a high vacuum and a fast removal of the nucleus fragments in safe conditions.

Simonetta Morselli

Coaxial microincision will soon be the everyday standard in cataract surgery, according to a surgeon.

“The technique is similar to what we have been traditionally doing in cataract surgery. The change that really matters is the phaco machine,” Simonetta Morselli, MD, said at a meeting earlier this year.

Surgeons cannot switch to coaxial microincision cataract surgery (MICS) by just modifying the parameters and changing the tip of their old phaco machines, she said. There are now new platforms with the capability of producing a high vacuum and, consequently, a fast removal of the nucleus fragments in safe conditions.

“One of them is the [Bausch & Lomb] Stellaris. Created specifically for MICS, this system is exceptionally fast and safe. It is amazing to see how quickly the nucleus fragments are removed while the chamber remains perfectly stable,” she said.

The machine is also versatile. It allows a variety of settings for optimized cutting with small tips for all degrees of nucleus hardness. Also, the sleeves are specifically designed to deal with microincision: They are thin and delicate, but allow good chamber stability because of the efficient irrigation.

“Needless to say, microincision is less traumatic, minimally invasive and safer. These new, dedicated platforms will allow this equally effective and more gentle approach to cataract surgery to become everyday practice,” Dr. Morselli said.

Addressing complications

Coaxial MICS can also be successfully carried out when intraoperative complications occur.

“A 1.8- to 2-mm incision is wide enough to manage minor complications,” she said.

Anterior vitrectomy can be performed with and without infusion in case of capsule rupture, and a bimanual technique of irrigation and aspiration with low bottle level can be an advantage in case of complications with vitreous loss.

In addition, the Akreos AO microincision lens (Bausch & Lomb) can easily be implanted in case of posterior capsule rupture, she said. This lens was conceived as a part of the Stellaris MICS platform. – by Michela Cimberle

• Simonetta Morselli, MD, is head of ophthalmology at Bassano del Grappa City Hospital. She can be reached at Ospedale San Bassiano, Unità Operativa di Oculistica, 36061 Bassano del Grappa (VI), Italy; e-mail: simonetta.morselli@gmail.com. Dr. Morselli has no direct financial interest in the products discussed in this article, nor is she a paid consultant for any companies mentioned.

The author’s experience confirms that we are facing a further evolution in cataract surgery, and specifically that we are switching to microincision surgery. The products described in this article are probably just the first of a new series.

This novel approach is affecting our clinical practice in two ways. On one hand, we are developing a safe and effective method of cataract removal and lens implantation through smaller incisions, preserving corneal anatomy. On the other hand, we are designing new machines and instruments that will increase our knowledge of both the surgery and the materials, further improving our results and promoting refractive lens exchange.

I think that the coaxial MICS technique is well-established at the moment. In the short term, future research will perfect the machines and the lenses. In particular, we need a sulcus IOL that can be implanted through a sub-2 mm incision for complicated cases.

– Roberto Bellucci, MD
Head of the Ophthalmology Department, Verona City Hospital, Italy