Some surgeons unconvinced of advantages of MICS

Daniel Perrone, MD, said he has found little reason to switch to MICS, which he considers more complicated than coaxial phaco.

BUENOS ARIES — Microincision cataract surgery has not demonstrated the advantages over conventional coaxial phaco that some practitioners have suggested, according to two surgeons speaking here at the Argentinean Society of Ophthalmology’s Annual Course. One supposed advantage of microincision cataract surgery (MICS), a reduction in induced astigmatism, is negated when the procedure is performed in combination with glaucoma surgery, said Daniel Perrone, MD. Dr. Perrone said he has found little reason to switch to MICS, which he considers more complicated than coaxial phaco.

“For me it is really more of an extreme sport. In my hands, coaxial phaco is safer,” Dr. Perrone said.

While the smaller incision used in MICS has been said to induce less astigmatism, this advantage is negated when MICS is done before nonpenetrating deep sclerectomy or trabeculectomy, he said.

“When we do glaucoma surgery [after MICS], .... penetrating and nonpenetrating surgery induce astigmatism because of the sutures,” Dr. Perrone said.

Another obstacle to the adoption of MICS is the unavailability of thin lenses in Latin America, he said.

Miguel Padilha, MD, a visiting speaker from Rio de Janeiro, Brazil, agreed that the IOL technology has not yet caught up with the bimanual technique. He also argued that MICS is not yet an appropriate alternative in Latin America, where the economic situation prevents investment in technological advances that have yet to demonstrate better outcomes than the standard of care.

“In Brazil, and I imagine here in Argentina and throughout South America, unfortunately there is no space to put more money into an area where the results are not absolutely convincing for the surgeons and especially for the patients,” Dr. Padilha said.

He said he has not seen convincing data that MICS improves visual results compared to coaxial phaco.

“At this moment, we are at a crossroads. Either we keep going forward with the latest generation aspheric and pseudoaccommodative lenses that we have now, or MICS is going to have to evolve a lot and quickly to conquer this terrain,” Dr. Padilha said.