Microincision Cataract Surgery with a Scleral Approach - PowerPoint PPT Presentation

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Microincision Cataract Surgery with a Scleral Approach

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Cataract Surgery with a Scleral Approach Jean Luc Febbraro MD Marlene Ostendorff MD Damien Gatinel MD Rothschild Foundation Paris France No financial interest – PowerPoint PPT presentation

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Title: Microincision Cataract Surgery with a Scleral Approach


1
Microincision Cataract Surgery with a Scleral
Approach
  • Jean Luc Febbraro MD
  • Marlene Ostendorff MD
  • Damien Gatinel MD
  • Rothschild Foundation
  • Paris
  • France

No financial interest
2
Purpose
  • To evaluate the  safety, the feasibility and the
     effectiveness of scleral microincision cataract
    surgery (S-MICS).
  •  
  •  Why S-MICS?
  • To improve the wound integrity and safety of
    microincision scleral incisions heal faster than
    corneal incision. (Ernest and Neuhann) 1,2,3
  •  

3
Materials Methods
  • 48 eyes
  • 1.8 mm S-MICS on steep axis
  • Topical anesthesia
  • Hydrophilic acrylic IOL
  • Wound assisted injection

4
Materials Methods
  • S-MICS
  • Location
  • 1.5 to 2 mm behind the limbus
  • Conjunctival miniperitomy (gt2mm)
  • Two plane square incision
  • Size
  • 1,8 x 1,8 mm
  • Scleral tunnel
  • Knife
  • Trapezoidal 1.6 X 1.8 mm metal blade

5
Results
  • Efficiency
  • Limited intraoperative bleeding (small
    conjunctival and scleral incisions)
  • Low incidence of chemosis (2 cases)
  • Self sealing in most cases (wound hydration in 4
    cases)
  • No postoperative leakage or hyphema
  • Fast visual recovery 75 gt 20/40 by 3 days po.

6
Results
  • Keratometric astigmatism
  • Pre and postoperative keratometry

S-MICS n48 Mean Preop Astig. Mean Postop Astig
K2-K1 0.59 /- 0,35 D 0,65 /- 0,35 D
S-MICS n48 K1 K2
Preop 43,30 /- 1,43 D 43,86 /- 1,48 D
Postop (3 months) 43,28 /- 1,48 D 43,90 /- 1,50 D
7
Discussion
  • Sub 2-mm microincision cataract surgery has
    proven to be effective and is gaining popularity
    worldwide.4,5
  • Sub 2-mm corneal incisions are not necessarily
    more stable.
  • Wound architecture errors, intraoperative
    stretching and ovalisation of clear corneal MICS
    may compromise wound self sealing and healing
    properties.

8
Discussion
  • In the 1990s Ernest cadavers and animal eyes
    studies have shown that 3 key parameters could
    influence wound construction 1,2,3
  • Geometry square incisions provide better
    stability, regardless of location.
  • Tissue properties elastin enables tissue to
    return to original configuration when stretched.
  • Histology fibroblasts speed wound healing.

9
Discussion
  • Clear corneal MICS is efficient but wound
    stretching or ovalisation may occur in spite of
    appropriate incision construction.
  • Scleral MICS has the following advantages
  • Allows for a 1.8 x 1.8-mm square scleral tunnel,
    more resistant to intraoperative stretching.
  • Optimum location with ideal tissue and
    histological properties to optimise self sealing
    and speed wound healing.
  • More flexible and forgiving in wound construction
    errors, enlargement or IOL exchange.

10
Conclusion
  • The scleral approach for microincision cataract
    surgery (S-MICS) is an efficient and safe
    alternative to clear corneal microincision.
  • It provides satisfactory self sealing and healing
    properties with very limited cons (bleeding and
    chemosis).
  • It provides flexibility in case of wound
    extension, IOL exchange and forgives wound
    architecture errors.

11
References
  1. Ernest P.H., Lavery K.T., Kiessling L.A. Relative
    Strength of Scleral Corneal Incisions Constructed
    in Cadavers Eyes. J Cataract Refract Surg.
    19942084-88
  2. Ernest P.H., Neuhann T. Posterior Limbal
    Incision. J Cataract Refract Surg. 19962278-84
  3. Ernest P.H. et al. Is There a Difference in
    Incision Healing Based on Location? J Cataract
    Refract Surg. 199824482-486
  4. Alio JL et al. Outcomes of Microincision Cataract
    Surgery Versus Coaxial Phacoemulsification.
    Ophthalmology. 20051121997-2003
  5. Alio JL et al. Visual Outcomes of Microincision
    Cataract with Implantation of Acry Smart Lens. J
    Cataract Refract Surg. 2005311549-1556
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