Bimanual Microincision Cataract Surgery Research Articles

Long-Term Evaluation of Capsulotomy Shape and Posterior Capsule Opacification after Low-Energy Bimanual Femtosecond Laser-Assisted Cataract Surgery.

Purpose To evaluate capsulotomy shape and posterior capsule opacification (PCO) during an 18-month follow-up for bimanual femtosecond laser-assisted cataract surgery (FLACS). Methods 74 eyes operated by a well-trained surgeon with bimanual FLACS technique using low-energy LDV Z8 (Ziemer Ophthalmic Systems AG, Port, Switzerland) were included in the study. The follow-up period was 18 ± 2 months. Another 91 eyes, which underwent standard bimanual microincision cataract surgery (B-MICS), served as a control group. In all cases, a BunnyLens AF (Hanita Lenses, Israel) intraocular lens was implanted in the bag. A digital image of the capsule with slit-lamp retroillumination was performed in all patients at 18 months of follow-up. Image analysis software (ImageJ) was used to evaluate the shape of the capsulotomy in terms of diameter, area, and circularity. PCO score was evaluated using EPCO 2000 software. Best corrected visual acuity (BCVA) and endothelial cell count (ECC) were evaluated before and after surgery at 1 and 18 ± 2 months. Results At 18 months, mean capsulotomy diameter was 5.34 ± 0.21 mm while capsulorhexis was 5.87 ± 0.37 mm (p < 0.001) and the deviation area from baseline was 1.13 ± 1.76 mm2 in FLACS and 2.67 ± 1.69 mm2 in B-MICS (p < 0.001). Capsulotomy circularity was 0.94 ± 0.04 while capsulorhexis was 0.83 ± 0.07 (p < 0.001). EPCO score was 0.050 ± 0.081 in the FLACS group and 0.122 ± 0.239 in the B-MICS group (p=0.03). The mean BCVA improvement was significant in both groups, without a significant difference at 18 months. We noticed a statistically significant difference in endothelial cell loss at 18 months (FLACS 12.4% and B-MICS 18.1%; p=0.017). Conclusions Bimanual FLACS is a safe and effective technique, as determined in a long-term follow-up. Capsulotomy shape presented higher stability and circularity in the FLACS group over the 18-month observation period. FLACS resulted in lower PCO scores and endothelial cell loss at 18 months in comparison to B-MICS standard technique.

Outcomes of bimanual microincision cataract surgery and 2.2-mm coaxial phacoemulsification

Purpose To compare the efficacy and safety outcomes of bimanual microincision cataract surgery (B-MICS) versus 2.2-mm coaxial phacoemulsification (C-MICS). Patients and methods This prospective, interventional, randomized, comparative clinical study was carried out on 60 cataractous eyes. Thirty patients were managed surgically by C-MICS through a 2.2 mm mean incision and 30 patients were managed surgically by B-MICS through a 1.2–1.4 mm trapezoidal incision. The main outcomes measures were postoperative best-corrected distant visual acuity, postoperative spherical equivalent, higher-order aberrations, corneal thickness, corneal endothelial cell loss (ECL), and complications during and after surgery. Both groups were compared for all variables preoperatively. Results The visual rehabilitation in group B was faster than that in group A (nonsignificant). There were nonstatistically significant differences, in the best-corrected visual acuity, between both groups throughout the postoperative period. The mean ECL was statistically significantly higher in group A (221.2±44.1) compared with group B (167.5±67.9) (P Conclusion The two techniques are reliable, functional, effective, and yield good visual outcomes and low complication rates. B-MICS with the smallest incision induces less astigmatism (surgically induced astigmatism), less ECL, fewer central corneal thickness changes, and enables earlier visual rehabilitation.

Bimanual microincision cataract surgery with implantation of the new Incise® MJ14 intraocular lens through a 1.4 mm incision.

To analyze the visual outcomes and the posterior capsule opacification (PCO) with the new Incise® MJ14 intraocular lens (IOL) implanted through a 1.4 mm clear corneal incision (CCI) in patients who underwent bimanual microincision cataract surgery (B-MICS). Eighty eyes which underwent cataract surgery using B-MICS technique performed by the same experienced surgeon were included in the study: 40 eyes were implanted with an Incise® MJ14 IOL through a 1.4 mm CCI (group A) without enlargement of the main CCI, while 40 eyes were implanted with an Akreos® MI60 IOL with enlargement of the main CCI to 1.8 mm (group B). Best corrected visual acuity (BCVA), astigmatism and endothelial cell loss were evaluated before and after surgery at 7, 30d and 6mo. Anterior segment-optical coherence tomography (AS-OCT) of CCI was performed at 1, 3, 7, 30d, 6 and 18mo. PCO incidence was evaluated at 18mo using EPCO 2000 Software. Mean BCVA improvement and endothelial cell loss were statistically significant at 18mo in both groups with no difference between the two groups; no statistically significant difference in surgically induced astigmatism (SIA) was noticed in the two groups. At AS-OCT the only significant alterations in the CCI were endothelial gaping and local detachment of Descemet's membrane at 1 and 7d after surgery; no statistically significant alterations were found at 1, 6 and 18mo. PCO score at 18mo was 0.03±0.07 for group A and 0.08±0.18 for group B (P=0.11) with no sign of central optic plate invasion in both groups. The implant of the new Incise® MJ14 IOL through a 1.4 mm CCI and B-MICS technique appeared to be a safe and effective procedure with rapid visual recovery. PCO rate resulted very low and the CCI presented few morphological alterations which were only detectable in the first days postoperatively and achieved fast corneal healing during the long-term follow-up.

Bimanual Microincision Cataract Surgery versus Coaxial Microincision Cataract Surgery: A Meta-Analysis of Randomized Controlled Trials and Cohort Studies.

Purpose This meta-analysis was conducted to compare the intraoperative and postoperative outcomes of bimanual microincision cataract surgery (B-MICS) and coaxial microincision cataract surgery (C-MICS). Methods Three databases were searched for papers that compared B-MICS and C-MICS from inception to June 2016. The following intraoperative and postoperative outcomes were included in the final meta-analysis: ultrasound time (UST), effective phacoemulsification time (EPT), balanced salt solution use (BSS use), mean surgery time, best-corrected visual acuity (BCVA), central corneal thickness (CCT), and increased CCT. Results There were no statistically significant differences in mean surgery time, UST, BSS use, BCVA, CCT, or increased CCT (one subgroup at postoperative day 7-8 and another subgroup at postoperative day 30). However, there was less EPT needed during surgery (p < 0.01) and lower levels of increased CCT at postoperative day 1 (p = 0.02) in the B-MICS group compared with the C-MICS group. Conclusions The EPT was shorter and increased CCT was less at postoperative day 1 in the B-MICS group. There were no statistically significant differences in other intraoperative and postoperative outcomes between the B-MICS group and the C-MICS group. B-MICS is an efficient and safe cataract surgery procedure.

Long-term follow-up for bimanual microincision cataract surgery: comparison of results obtained by surgeons in training and experienced surgeons.

PurposeTo determine the efficacy of bimanual microincision cataract surgery (B-MICS) performed by surgeons in training, evaluating clinical results, posterior capsule opacification (PCO) incidence, and clear corneal incision (CCI) architecture in a long-term follow-up and comparing results with those obtained by experienced surgeons.Patients and methodsEighty eyes of 62 patients operated on by three surgeons in training who used B-MICS technique for the first time were included in the study (Group A). Eighty eyes of 59 patients who underwent B-MICS by three experienced surgeons were included as a control group (Group B). Best corrected visual acuity, astigmatism, corneal pachymetry, and endothelial cell count were evaluated before surgery and at 1 month and 18 months after surgery. Anterior segment optical coherence tomography images were obtained to study the morphology of CCIs. PCO incidence was evaluated using EPCO2000 software.ResultsOut of 160 surgeries included in the study, mean best-corrected visual acuity improvement at 18 months was 0.343±0.246 logMAR for Group A, and 0.388±0.175 logMAR for Group B, respectively. We found no statistically significant induced astigmatism nor corneal pachymetry changes in either group, while we noticed a statistically significant endothelial cell loss postoperatively in both groups (P<0.05). In Group A, mean PCO score was 0.163±0.196, while for Group B, it was 0.057±0.132 (P=0.0025). Mean length and inclination of the CCIs for Group A and Group B were, respectively, 1,358±175 µm and 1,437±256 µm and 141.8°±6.4° and 148.7°±5.1°. As regards corneal architecture in the 320 CCIs considered, we found posterior wound retractions and endothelial gaps, respectively, 9.8% and 11.6% for Group A and 7.8% and 10.8% for Group B.ConclusionB-MICS performed by surgeons in training is an effective surgical technique even when assessed after a long-term follow-up. PCO incidence resulted in being higher for less experienced surgeons. Corneal incisions were shorter and less angled in surgeons in training in comparison with results obtained by expert surgeons.

Results and complications of surgeons-in-training learning bimanual microincision cataract surgery

To evaluate visual outcomes and complications of bimanual microincision cataract surgery performed by surgeons in training. Institute of Ophthalmology, University of Modena and Reggio Emilia, Modena, Italy. Prospective case series. The corrected distance visual acuity (CDVA), astigmatism, corneal pachymetry, and endothelial cell count were evaluated before and 7 and 30 days after bimanual MICS performed by surgeons in training. Intraoperative and postoperative complications were also recorded. Three surgeons in training performed bimanual MICS in 150 eyes of 131 patients. There were 18 intraoperative complications (12.0%) (10 iris traumas [6.6%]; 4 capsule ruptures without vitreous loss [2.7%]; 3 capsule ruptures with vitreous loss [2.0%]; 1 intraocular lens [IOL] implantation in the sulcus due to zonular laxity [0.7%]). There were 5 postoperative complications (3.3%) (2 iris prolapses [1.3%]; 1 IOL loop malposition [0.7%]; 1 narrowing of anterior chamber [0.7%]; 1 capsulorhexis phimosis [0.7%]). Thirty days postoperatively, the mean CDVA improvement was 0.53 ± 0.20 (Snellen decimal) (P < .05), the mean decrease in astigmatism was 0.09 ± 0.54 diopter (P = .29), and the mean increase in corneal pachymetry was 7.42 ± 22.01 μm (P = .12). There was statistically significant endothelial cell loss (mean 496.50 ± 469.66 cells/mm(2)) (P < .05). Bimanual MICS performed by surgeons in training was safe and effective. Visual outcomes and complication rates were similar to those reported for coaxial cataract surgery performed by surgeons in training. No author has a financial or proprietary interest in any material or method mentioned.

Bimanual microincision versus standard coaxial small-incision cataract surgery: meta-analysis of randomized controlled trials.

This meta-analysis aimed to evaluate the outcomes of bimanual microincision cataract surgery (B-MICS) through a 1.2- to 1.5-mm incision versus standard coaxial small-incision cataract surgery (C-SICS) through a 2.8- to 3.2-mm incision. A comprehensive literature search was performed according to the Cochrane Collaboration methodology to identify randomized controlled clinical trials comparing B-MICS with standard C-SICS. Main outcome measures were mean surgical time, mean phacoemulsification power, effective phacoemulsification time, best-corrected visual acuity, surgically induced astigmatism (SIA), mean laser flare photometry values, mean endothelial cell loss, mean increased central corneal thickness, and intraoperative and postoperative complications. We identified 14 randomized controlled clinical trials that included 1235 eyes diagnosed with cataracts. No statistically significant differences were detected between the 2 surgical procedures in terms of best-corrected visual acuity (p&gt;0.05), SIA at postoperative 1 month (p = 0.09), laser flare photometry values (p = 0.38), mean endothelial cell loss (p = 0.53), increased central corneal thickness at postoperative 1 month (p = 0.64) or 3 months (p = 0.88), intraoperative complications (p = 0.68), and postoperative complications (p = 0.30); however, statistically significant differences were apparent for mean surgical time (p&lt;0.00001), mean phacoemulsification power (p = 0.008), effective phacoemulsification time (p = 0.0009), SIA at postoperative 3 months (p = 0.02), and increased central corneal thickness at postoperative 1 day (p = 0.04). The meta-analysis shows that the 2 techniques have similar outcomes in terms of final visual acuity and complications. Bimanual MICS has the advantage of less SIA and phaco time whereas C-SICS has the advantage of quicker surgery and less likelihood of early-onset corneal edema.

Machines and Cutters: Stellaris PC.

The Stellaris PC (Bausch & Lomb) is a versatile platform that allows surgeons to perform both anterior segment and posterior segment surgeries. It was developed based on the Stellaris microincision cataract surgery system and can therefore perform <2-mm coaxial or bimanual microincision cataract surgery in combination with posterior segment surgery. Similar to Millenium, its predecessor, the Stellaris PC has an open architecture with modular design that allows products and instruments manufactured by other companies to be used with the system. Vitrectomy can be performed using the traditional 20-gauge system or with microincision 23- or 25-gauge transconjunctival sutureless vitrectomy systems. The special design of the vitreous cutter with increased port area, improved fluidics, and optimized port open time makes the Stellaris PC an efficient system for performing microincision vitrectomy surgery. This article will describe the design, features, and details of various components of the Stellaris PC, including machine controls, entry site alignment trocar/cannula system, fluidics, and high-speed vitreous cutter, as well as its unique illumination system.

Temperature profiles of sleeveless and coaxial phacoemulsification

To study the temperature profile at the corneal wound during 2 sleeveless techniques versus 2 coaxial phacoemulsification techniques. Department of Ophthalmology, Meir Medical Center, Kfar Saba and Ein-Tal Eye Center, Tel-Aviv, Israel. Experimental study. Thirty-six porcine eyes were randomized into 4 groups: Group 1: conventional coaxial system (3.0 mm incision); Group 2: coaxial microincision cataract surgery (MICS) system (2.2 mm incision); Group 3: bimanual MICS (1.1 mm incision); Group 4: sleeveless tri-MICS (1.1 mm incision) using a 19-gauge anterior chamber maintainer as the sole fluid source. Temperature measurements were taken using a thermocouple and an infrared thermal imaging system. Measurements were taken in 2 settings; that is, with and without occlusion. With no occlusion, corneal burns did not occur in any group. However, corneal temperatures were lower with the sleeveless systems (Groups 3 and 4) than with the coaxial systems (Groups 1 and 2) (P=.0003). When occlusion was induced, temperatures were kept constantly low in the sleeveless groups, whereas in the coaxial groups, temperatures increased rapidly, causing corneal burns within seconds. The mean temperature elevations at the incision sites were 39 °C, 48.5 °C, 13.6 °C, and 11.3 °C in Groups 1, 2, 3, and 4, respectively (P<.0001). Sleeveless phacoemulsification maintained lower tissue temperatures than sleeved coaxial methods. During occlusion, fluid flow around the naked tip of the sleeveless systems prevented heat accumulation and corneal burns.

23- vs 20-gauge pars plana vitrectomy in combination with bimanual microincisional cataract surgery (b-MICS) for the treatment of macular hole and cataract as a one-step procedure

23-gauge pars plana vitrectomy (ppv) is a new method for vitreo-retinal surgery. It may reduce operation time, the risk of complications, and patient discomfort, especially in combination with simultaneous bimanual microincisional cataract surgery (b-MICS). Seventy-five consecutive patients who underwent combined cataract surgery and ppv at our center between 1 January 2008 and 31 December 2010 were included. The first 36 patients were treated with 20-gauge ppv, the following 39 patients with 23-gauge ppv. Study end points 8 weeks after surgery were duration of the procedure, improvement of visual acuity, and occurrence of complications. Duration of surgery was reduced in 23- vs 20-gauge ppv (54.0 ± 11.6 vs 61.0 ± 19.0 min, P=0.08). Visual acuity improved significantly in both the groups (20-gauge: logMAR 0.750 ± 0.304 before and 0.369 ± 0.273 after surgery; 23-gauge: logMAR 0.663 ± 0.340 before and 0.339 ± 0.273 after surgery). There were no appreciable group differences in baseline or post-treatment visual acuity. 23-gauge ppv in combination with b-MICS is a suitable, safe, and effective method for the treatment of combined cataract and vitreo-retinal diseases. The procedure is somewhat shorter and patient discomfort during and after surgery is improved. In terms of efficacy and safety, 23-gauge ppv is equivalent with conventional 20-gauge ppv.

Clear corneal incisions in bimanual microincision cataract surgery: Long-term wound-healing architecture

To evaluate bimanual microincision cataract surgery (MICS) clear corneal incision (CCI) architectural features over the long-term using anterior segment optical coherence tomography (AS-OCT). Case series. Institute of Ophthalmology, University of Modena, Modena, Italy. Patients who had uneventful bimanual MICS in the previous 2 to 16 months were examined using AS-OCT. Images were used to measure corneal thickness, incision length, incision angle, incidence of epithelial or endothelial gaping, misalignment, Descemet membrane detachment, and posterior wound retraction. Fifty-two eyes (33 patients) were enrolled. Mean incision length and incision angle were, respectively, 1427.91 μm and 31.19 degrees for the right hand, 1440.63 μm and 31.54 degrees for the left hand, 1474.13 μm and 31.27 degrees for temporal incisions, and 1394.41 μm and 31.46 degrees for nasal CCIs. Posterior wound retraction was the only architectural feature found. Its prevalence was 7.10% at 2 to 3 months, 31.8% at 4 to 11 months, and 33.3% at 12 months. Fifty-three percent of posterior wound retractions were in 1.8 mm CCIs and 47% in 1.4 mm CCIs. Bimanual MICS was not related to particular morphologic features of CCIs. The enlargement of 1 incision or construction of the incision with the dominant or the nondominant 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.

Quantitative measurement of wound architecture in microincision cataract surgery

To evaluate whether changes in internal wound architecture after phacoemulsification can be measured quantitatively by analysis of scanning electron micrographs. Baylor College of Medicine, Houston, Texas, USA. Experimental study. Two comparative studies in human cadaver eyes were performed using coaxial small-incision cataract surgery (SICS), bimanual microincision cataract surgery (MICS), coaxial MICS, and a variety of phacoemulsification tips (MicroSurgical Technologies, Microphaco Tapered, Microtip Turbosonics, and Microphaco Mackool). After surgery, the cornea and scleral rims were harvested and digital scanning electron micrographs were taken. The internal corneal wound was analyzed using measurement software to determine the area of endothelial cell loss and length of Descemet membrane tears. Quantifiable differences were observed between combinations of techniques and tip designs. The mean area of endothelial cell loss was 2.93 ± 0.31 mm(2) (SD) after coaxial MICS (n = 4) and 2.85 ± 0.54 mm(2) after bimanual MICS (n = 4). However, after normalizing for differences in tip or sleeve diameter, the area of endothelial cell loss ranged from 1.4-fold to 1.7-fold less with coaxial SICS than with bimanual MICS with Microphaco Tapered, Microtip Turbosonics, and Microphaco Mackool tips. The mean total length of tearing was 1.38 ± 0.38 mm for bimanual MICS (n = 4) and 0.84 ± 0.61 mm for coaxial MICS (n = 4). The length and area of corneal wounds could be quantitated with accuracy and the measurements could be used to make quantifiable comparisons of phacoemulsification techniques and tips. Dr. Dimalanta is an employee of Alcon Research, Ltd. No other author has a financial or proprietary interest in any material or method mentioned.

Phacoemulsification and acrylic intraocular lens in uveitis: A comparative study

ObjectiveTo describe the outcomes of phacoemulsification with the implant of an acrylic intraocular lens (IOL) in cataracts of adult patients with and without uveitis. MethodsDescriptive retrospective comparative study of 35 patients (45 eyes) with uveitis (group 1) and 38 (44 eyes) control patients (group 2), who were operated on by the same surgeon, and were homogeneous as regards sex, surgical technique, IOL (hydrophobic or hydrophilic) and follow-up. The pre-surgical characteristics of risk, the difficulties and intra-surgical and postsurgical complications, the date of posterior capsulotomy and the pre- and post-surgical visual acuity (VA), were analyzed. ResultsIn both groups the coaxial phacoemulsification was used in 75% of the eyes, bimanual microincision cataract surgery (MICS) in 20% and micro-coaxial in the rest. The pre-surgical risk factors (P=0.002, OR 6.83), the surgical difficulties and complications (P=0.001, OR 7.54) and postsurgical complications (P=0.069, OR 3.42) were more frequent in the uveitis group. In both 93% and 91%, respectively, of eyes improved 2 or more lines of VA. After an average follow-up of 4.9 years in both groups, 22.7% and 32% eyes (log-rank P=0.357) needed PC. The hydrophilic IOLs needed PC earlier than the hydrophobic ones (log rank P=0.001), neither the location nor the uveitis course influenced the PC rate. ConclusionsThe consequences because of previous ocular inflammation make cataract surgery in uveitis more difficult, but with postsurgical complications, visual results and need of PC similar to our patients without inflammation.

Facoemulsificación con implante de lente acrílica en pacientes con uveítis: estudio comparativo

Objective To describe the outcomes of phacoemulsification with the implant of an acrylic intraocular lens (IOL) in cataracts of adult patients with and without uveitis Methods Descriptive retrospective comparative study of 35 patients (45 eyes) with uveitis (group 1) and 38 (44 eyes) control patients (group 2), who were operated on by the same surgeon, and were homogeneous as regards sex, surgical technique, IOL (hydrophobic or hydrophilic) and follow-up. The pre-surgical characteristics of risk, the difficulties and intra-surgical and postsurgical complications, the date of posterior capsulotomy (PC) and the pre- and post-surgical visual acuity (VA), were analysed. Results In both groups the coaxial phacoemulsification was used in 75% of the eyes, bimanual microincision cataract surgery (MICS) in 20% and micro-coaxial in the rest. The pre-surgical risk factors ( P=.002, OR 6.83), the surgical difficulties and complications ( P=.001, OR 7.54) and postsurgical complications ( P=.069, OR 3.42) were more frequent in the uveitis group. In both 93% and 91% respectively of eyes improved 2 or more lines of VA. After an average follow-up of 4.9 years in both groups, 22.7% and 32% eyes (log-rank P=.357) needed PC. The hydrophilic IOLs needed PC earlier than the hydrophobic ones (log rank P=.001), neither the location nor the uveitis course influenced the PC rate. Conclusions The consequences because of previous ocular inflammation make cataract surgery in uveitis more difficult, but with postsurgical complications, visual results and need of PC similar to our patients without inflammation.

Prospective Randomized Trial of Limbal Relaxing Incisions Combined with Microincision Cataract Surgery

To evaluate clinical outcomes of limbal relaxing incision (LRI) combined with bimanual phacoemulsification and insertion of an intraocular lens (IOL) developed for bimanual microincision cataract surgery (MICS). In a prospective, single-center study, eyes with > or = 0.75 diopters (D) of keratometric astigmatism were randomly assigned to two surgical techniques: 1) bimanual MICS (non-LRI group) or 2) LRI combined with bimanual MICS (LRI group). Postoperative uncorrected distance visual acuity (UDVA), corrected distance visual acuity (CDVA), postoperative refractive error, corneal topography, and vector analysis of keratometric change between pre- and postoperative eyes were compared. In all cases of astigmatism in the LRI group, incisions for phacoemulsification and IOL insertion did not overlap or affect the LRIs. Uncorrected distance visual acuity was significantly higher in the LRI group (mean: 0.94) than in the non-LRI group (mean: 0.71, P = .009), although no difference was seen in CDVA in either group. Postoperative cylindrical error was significantly lower in the LRI group than in the non-LRI group (0.56 D and 1.51 D, respectively, P = .0004). Cravy analysis showed that the vector change in cylinder was 1.44 D in the LRI group and 0.18 D in the non-LRI group (P = .0007). Limbal relaxing incision with bimanual MICS is an easy-to-follow combined surgery to correct preexisting astigmatism with predictable accuracy.

Bimanual Microincisional Phacoemulsification Combined with Viscocanalostomy plus Deeper Sclerectomy

The aim of the study was to evaluate the safety and effectiveness of a new technique, two-site bimanual microincisional cataract surgery combined with viscocanalostomy plus deeper sclerectomy (two-site bimanual MICS-VC-DS), in patients with cataract and glaucoma. Noncomparative, interventional case series. From December 2005 to October 2007, a consecutive series of 12 patients (12 eyes) with uncontrolled primary open angle glaucoma (POAG) and cataract have undergone two-site bimanual MICS-VC-DS. Postoperative evaluation included visual acuity (VA), intraocular pressure (IOP), average retinal nerve fiber layer (RNFL) thickness measurement, and gonioscopic, biomicroscopic, and funduscopic examination. Paired-samples t test was used. A p value of <0.05 was taken as significant. The mean duration of follow-up was 14.6 months (SD 5.8). At 9 months, mean IOP was 17.0 (SD 4), the mean IOP reduction was 13.2 mmHg (SD 5.86). At 9 months post-surgery, the complete success rate was 75%. Qualified success was achieved in 100% of patients. At 9 months, the mean number of antiglaucoma medications was 0.58 (SD 1.24) (p<0.05). Visual acuity improved by a mean value of 2.8 lines. Average RNFL thickness did not change significantly during the follow-up period (p=0.781). Two-site bimanual MICS-VC-DS appears to be an effective and safe procedure with quick visual rehabilitation, acceptable mid-term IOP control, and the advantage of having fewer complications.

Impact of nepafenac 0.1% on macular thickness and postoperative visual acuity after cataract surgery in patients at low risk for cystoid macular oedema

To evaluate the use of topical nepafenac 0.1% after routine phacoemulsification in patients at low risk for cystoid macular oedema (CME) using optical coherence tomography (OCT) measurement of macular thickness. Seventy-nine subjects with no risk factors for CME had uncomplicated bimanual micro-incision cataract surgery by an experienced surgeon. All subjects received preoperative nepafenac. Subjects were randomised to postoperative standard of care, consisting of a topical antibiotic for 10 days and topical corticosteroid for 1 month (control), or standard of care plus nepafenac for 1 month (treatment). OCT and ETDRS best-corrected visual acuity were measured preoperatively and 2 months postoperatively. Primary endpoints were comparison of changes in macular thickness between groups and the relationship of that change to postoperative vision. All subjects had excellent visual outcomes, with mean visual improvement of 15 letters. Cataract surgery was very efficient with a mean effective phaco time (EPT) of 4.99 and 6.90 s in the control and treatment groups, respectively. There were small increases in the central macular thickness in both the control (2.78 microm) and treatment (5.60 microm) groups. The change in macular thickness was statistically similar between groups and did not correlate with the final visual outcome. The small increase in macular thickness after routine cataract surgery is probably not clinically significant. In subjects undergoing routine cataract surgery, and at low risk for CME, the routine use of preoperative nepafenac may be all that is necessary to achieve excellent visual recovery.

Comparison Between Bimanual Microincisional Cataract Surgery and Conventional Coaxial Phacoemulsification

Purpose: To evaluate corneal endothelial cell changes after conventional coaxial phacoemulsification and bimanual microincision cataract surgery (MICS). Methods: Forty patients were divided into 2 groups, coaxial phacoemulsification (Group 1, n=20), and MICS (Group 2, n=20). To evaluate corneal endothelial cell changes after coaxial phacoemulsification and bimanual MICS, intraoperative phacoemulsification power and volume of intraoperative irrigation solution (balanced salt solution, BSS, Alcon, U.S.A) were measured. Central corneal thickness and endothelial cell count were also evaluated, preoperatively and at 1 week, and 2 months postoperatively. Results: Between the 2 groups, there was no statistically significant difference in intraoperative phacoemulsification power and volume of intraoperative irrigation solution (balanced salt solution, BSS, Alcon, U.S.A.) (p＞0.05). In addition, there was no statistically significant difference between the 2 groups in endothelial cell count and central corneal thickness (p＞0.05). Conclusions: When comparing bimanual MICS and conventional coaxial phacoemulsification, bimanual MICS appears to have similar endothelial cell changes. In conclusion, MICS has the same safety as compared to coaxial phacoemulsification.

Two-site Phacotrabeculectomy versus Bimanual Microincision Cataract Surgery Combined with Trabeculectomy

To compare the results of two-site phacotrabeculectomy with microincision cataract surgery (MICS) and trabeculectomy. Fifty-eight eyes with coexisting cataract and glaucoma were randomly assigned to have a trabeculectomy in a superior quadrant combined with phacoemulsification and intraocular lens (IOL) implantation through temporal clear corneal incision (two-site phacotrabeculectomy group), or a trabeculectomy in a superior quadrant combined with MICS followed by IOL implantation from the trabeculectomy incision (MICS + trabeculectomy group). The main outcome measures were preoperative and postoperative intraocular pressure (IOP), number of glaucoma medications, best-corrected visual acuity (BCVA), and complications. Follow-up was period was 12 months. Twenty-eight two-site phacotrabeculectomies and 30 MICS + trabeculectomies were performed. Mean age of the subjects was 67.4 years. Mean preoperative IOP was 24.6+/-5.7 mmHg in the two-site phacotrabeculectomy group and 23.7+/-5.5 mmHg in the MICS + trabeculectomy group (p=0.52). At 12 months postoperatively mean IOP was 14.5+/-3.0 and 14.3+/-3.4 mmHg in two-site phacotrabeculectomy and MICS + trabeculectomy groups, respectively (p=0.8). Preoperative and postoperative glaucoma medication numbers were similar and mean number of glaucoma medications decreased in both groups after the surgery (p<0.05). BCVA improved in both groups. Twenty-six of 28 eyes (92%) in the two-site + trabeculectomy group and 27 of 30 (90%) in the MICS + trabeculectomy group had clinically apparent filtering blebs at 12 months (p=0.71). Postoperative complications were comparable. MICS + trabeculectomy provided 1 year IOP control comparable to that with two-site phacotrabeculectomy with similar amount of complications and similar final BCVA.

Uncorrected visual acuity in the immediate postoperative period following uncomplicated cataract surgery: bimanual microincision cataract surgery versus standard coaxial phacoemulsification

We compared bimanual microincision cataract surgery (MICS) and standard coaxial phacoemulsification (CAP) in terms of uncorrected visual acuity (UCVA) recorded 1 h and 2 weeks postoperatively. This was a prospective, nonrandomised comparative study. All MICS procedures were performed by one surgeon (MGM), and all CAP procedures were performed by another surgeon (SB). Eyes with visually consequential ocular morbidity were excluded. The primary outcome measure was UCVA recorded 1 h postoperatively. One hundred eyes underwent MICS and CAP (50 eyes in each group). The treatment groups did not differ significantly in terms of preoperative mean best corrected visual acuity (6/24 +/- 4.3 lines and 6/20 +/- 4.4 lines in the MICS and the CAP groups, respectively; P = 0.65). Also, there was no significant difference in terms of postoperative UCVA at 1 h or at 2 weeks (mean +/- standard deviation UCVA 1 h postoperatively: MICS: 6/36 +/- 5.7 lines; CAP: 6/30 +/- 4.7 lines; P = 0.80; UCVA 2 weeks postoperatively: MICS: 6/10 +/- 1.9 lines; CAP: 6/10 +/- 2.2 lines; P = 0.90). However, nine eyes (18%) and one eye (2%) achieved a UCVA of C6/12 at 1 h following MICS and CAP, respectively, and this difference was statistically significant (P = 0.02). Mean UCVA at 1 h and at 2 weeks following cataract surgery was not significantly different between eyes undergoing MICS and CAP. However, a greater proportion of patients achieved a UCVA of C6/12 following MICS when compared with CAP.