MICS complications subside after learning curve, surgeon says

CHICAGO — Once a surgeon has completed the learning curve, the complications of microincision cataract surgery are similar to those of standard phacoemulsification, said Paul S. Koch, MD, here at the American Academy of Ophthalmology meeting.

“This is really a bit of an easy talk, because there are no complications with MICS,” he joked to attendees. While the surgeon is learning the technique, however, there are some potential obstacles to overcome, he added.

By definition, the technique requires small and tight incisions, he said, and surgeons should be wary of separation of Descemet’s membrane upon entry into the anterior chamber.

Dr. Koch said many surgeons use three incisions for MICS: two 1.5-mm incisions for cataract removal and one 2.8-mm incision for lens implantation, bringing the cumulative incision length to 5.8 mm.

“Standard phaco uses 3.2 mm,” he said. “MICS requires 52% more incision, not less.”

Infusion volume is less than in standard phaco, but if there is a single bore at the tip of the irrigating instrument it can push away tissue, he said.

“That’s not necessarily a bad thing,” Dr. Koch said. “If there’s a double bore at the sides, it can come out of the anterior chamber if the instrument is pulled towards the incision.”

Aspiration must be controlled to prevent chamber collapse, Dr. Koch said, and lower levels of vacuum are needed compared to standard phaco to maintain chamber stability.

Using MICS increases surgical time, Dr. Koch said.

“It is a less cost-effective and more expensive procedure than standard phaco for the surgeon and the facility,” he said.

During the interactive session, audience members were polled electronically on their experience with MICS. A large majority, 81%, said they had never tried MICS; 16% said they had tried it, but preferred coaxial; and 3% reported preferring MICS. Another poll question showed that 71% of the audience said MICS is a “minor improvement” over standard phaco.