This article is more than 5 years old. Information may no longer be current.
Bimanual MICS may not affect clear corneal incision architecture, healing
Bimanual microincision cataract surgery did not result in morphologic features of clear corneal incisions affecting wound closure, according to a study.
“The enlargement of one incision or construction of the incision with the dominant or the non-dominant hand did not affect long-term wound architecture. Posterior wound retraction was the only architectural feature; however, its prevalence seems substantially lower than with other surgical techniques,” the study authors said.
The case series included 52 eyes of 33 patients who underwent bimanual microincision cataract surgery (MICS) and IOL implantation with two 1.4-mm trapezoidal incisions at the 10 o'clock and 2 o'clock positions. Mean patient age was 71.82 years.
Non-contact anterior segment optical coherence tomography images were used to measure corneal thickness, incision length, incision angle, epithelial or endothelial gaping, misalignment, Descemet’s membrane detachment and posterior wound retraction 2 to 16 months postoperatively.
Study results showed that overall mean corneal thickness was 717.15 μm, mean incision length was 1,434 μm, and mean incision angle was 31.36˚.
Mean incision length was 1,427.91 μm for the right hand, 1,440.63 μm for the left hand, 1,474.13 μm for temporal incisions and 1,394.41 μm for nasal incisions.
Mean incision angle was 31.19˚ for the right hand, 31.54˚ for the left hand, 31.27˚ for temporal incisions, and 31.46˚ for nasal incisions.
No epithelial gaps, Descemet’s membrane flaps or roof-floor misalignments were identified.
Thirty incisions showed evidence of posterior wound retraction, but most retractions were minimal, the authors said.
Perspective
Back to TopThis paper analyzes the quality of the corneal incisions following bimanual microincision cataract surgery (MICS). MICS is a concept in which incision size is reduced, aiming to reduce surgical trauma, to provide total control on the surgically induced astigmatism and induction of corneal aberrations by the surgery, and to improve the previous decrease in total phaco power and effective phaco time in cataract surgery. In summary, it targets a more efficient phacoemulsification process. Extensive literature exists on the topic about its efficacy in the above-mentioned goals, which are totally achieved once MICS has been accomplished by the surgeon following a shorter incision period.
In this paper, it is confirmed that MICS does not cause any deterioration of the incisions despite the lack of the sleeve to protect the titanium tip of the phacoemulsification handpiece from the corneal tissue. These findings correlate well with the clinical findings and the clinical experience. MICS is a safe technique for the cornea as it is used with adequate phacoemulsification parameters and with adequate training. MICS is confirmed to be equivalent to coaxial phacoemulsification with the proven advantages of control of the corneal optical performance, essential for the correction of astigmatism and corneal aberrations with modern IOLs, improving at the same time phacoemulsification efficiency.