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Ultrasound power, phaco time reduced in laser-assisted MICS
Femtosecond laser-assisted bimanual microincision cataract surgery is more efficient with regard to ultrasound power and effective phacoemulsification time than femtosecond laser-assisted coaxial phacoemulsification, according to study.
In a prospective randomized study, 25 patients underwent bimanual MICS with two 1-mm incisions and 25 patients underwent coaxial phacoemulsification with a 1-mm paracentesis and 2.2-mm principal incision. The LenSx femtosecond laser (Alcon) was used to create incisions, perform capsulotomies and fragment lenses in all cases.
Mean patient age was 67.6 years in the MICS group and 70.5 years in the coaxial incision group.
Investigators evaluated visual, refractive and anatomic outcomes, as well as complications at 1 month postoperatively.
Mean postoperative uncorrected distance visual acuity at 1 month was 0.27 in the MICS group and 0.26 in the coaxial phacoemsulsification group. Mean postoperative corrected distance visual acuity was 0.20 in the MICS group and 0.15 in the coaxial group.
Mean postoperative spherical equivalent was –0.26 in the MICS group and –0.33 in the coaxial group.
Mean ultrasound power was 1.8% in the MICS group and 14.7% in the coaxial incision group; the between-group difference was statistically significant (P < .001).
Mean effective phacoemulsification time was 1.5 seconds in the MICS group and 4.5 seconds in the coaxial group (P = .002).
Both groups had similar corneal thickness, endothelial cell counts, macular thickness and complications.
Disclosure: The study authors have no relevant financial disclosures.
Perspective
Back to TopAlio and colleagues compared two cohorts of patients undergoing routine phaco and IOL surgery, bimanual MICS versus a 2.2- mm coaxial traditional approach, both in conjunction with a femtosecond LensX laser used to perform most of the penetrating incisions, the capsulorrhexis and lens fragmentation. Both procedures were found to have comparable visual outcomes. As these authors have previously reported in non-laser assisted surgery, in their hands the bi-manual MICS patients required less effective phaco time and were considered to be more efficient cases. No significant differences were seen in the rate of complications, the most common problem being incomplete capsulorrhexis' in both groups.
It should be noted that different surgeons performed the MICS cases versus the co-axial surgeries, but all were experienced in their respective techniques. As these authors have previously reported, mean higher-order aberrations were lower in the MICS group versus the coaxial cohort. It would be interesting to compare 1.8 mm coaxial cases to a similar group of bimanual MICS patients, as the differences might be less pronounced. Despite the theoretical advantages of a bimanual technique, most surgeons still prefer a coaxial approach.
This study shows that femtosecond laser technology appears to be applicable and helpful for both traditional coaxial small-incision surgery and bimanual MICS techniques.