Microcoaxial phaco using 1.8mm incisions:

comparison of two machines and IOL systems

Microcoaxial phaco using 1.8mm incisions:

comparison of two machines and IOL systems

Richard Packard Windsor EnglandConsultant for Alcon, AMO and Bausch and Lomb

Richard Packard Windsor EnglandConsultant for Alcon, AMO and Bausch and Lomb

Reasons for making incisions smaller

• Less leakage and therefore better controlled surgery

• Minimal if any induced astigmatism

• Faster rehabilitation visually for the patient

• Safer more rapidly healing wounds

• Because we can!

• Less leakage and therefore better controlled surgery

• Minimal if any induced astigmatism

• Faster rehabilitation visually for the patient

• Safer more rapidly healing wounds

• Because we can!

0.5

0.25

0.12

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0.05

0.10

0.15

0.20

0.25

0.30

0.35

0.40

0.45

0.50

Induced astigmatism from temporal wounds

3.2mm 2.5mm 2.2mm 1.8mm

Microincisions with coaxial give:Microincisions with coaxial give:

• Protected wounds due to sleeve

• Less changes in technique and equipment than B-MICS

• Ability to use established IOL technology

• Minimal astigmatism

• Protected wounds due to sleeve

• Less changes in technique and equipment than B-MICS

• Ability to use established IOL technology

• Minimal astigmatism

What do we need for C-MICSWhat do we need for C-MICS• Wounds and therefore knives that match instrumentation

• Microsurgical capsulorhexis forceps

• New sleeves that are thin and allow enough fluid passage

• Thinner phaco tips?

• Understanding hydrodissection with microincisions

• No change in cataract removal techniques

• Phaco machines with appropriate power modulation and excellent fluidics

• IOLs capable of being injected with wound assistance through unopened Co-MICS incisions

• Wounds and therefore knives that match instrumentation

• Microsurgical capsulorhexis forceps

• New sleeves that are thin and allow enough fluid passage

• Thinner phaco tips?

• Understanding hydrodissection with microincisions

• No change in cataract removal techniques

• Phaco machines with appropriate power modulation and excellent fluidics

• IOLs capable of being injected with wound assistance through unopened Co-MICS incisions

Incisions for 1.8mm C-MICSIncisions for 1.8mm C-MICS

Capsulorhexis and hydrosteps and tip insertion for 1.8mm C-MICS

Capsulorhexis and hydrosteps and tip insertion for 1.8mm C-MICS

Stellaris System Overview Stellaris System Overview

• EQ Fluidics equalises fluidic dynamics for solid chamber stability in vacuum or flow modes

• Ergonomic six crystal handpiece and tubing for efficient cutting and smooth removal of the nucleus in all techniques

• CustomControl™ Software II for customisable power modulation for all cataract grades

• Wireless Dual Linear foot pedal for instantaneous surgeon control of aspiration and ultrasound

• Sleek and ergonomically designed for operating room efficiency

• Modular design customisable to both EQ Fluidics options, the Advanced Flow Module or Vacuum Fluidics Module, plus all future upgrades

• EQ Fluidics equalises fluidic dynamics for solid chamber stability in vacuum or flow modes

• Ergonomic six crystal handpiece and tubing for efficient cutting and smooth removal of the nucleus in all techniques

• CustomControl™ Software II for customisable power modulation for all cataract grades

• Wireless Dual Linear foot pedal for instantaneous surgeon control of aspiration and ultrasound

• Sleek and ergonomically designed for operating room efficiency

• Modular design customisable to both EQ Fluidics options, the Advanced Flow Module or Vacuum Fluidics Module, plus all future upgrades

Stellaris EQ Fluidics Management Technology Stellaris EQ Fluidics Management Technology

EQAdvanced Flow Module (AFM)

EQAdvanced Flow Module (AFM)

EQVacuum Fluidics

Module (VFM)

EQVacuum Fluidics

Module (VFM)

EQualising aspiration and irrigation for unsurpassed

safety, efficiency and predictability in either flow or

vacuum modes for solid chamber stability throughout

the procedure

EQualising aspiration and irrigation for unsurpassed

safety, efficiency and predictability in either flow or

vacuum modes for solid chamber stability throughout

the procedure

Single module allows surgeons to toggle intra-operatively between flow

and vacuum modes; flow for sculpting, vacuum for capsule

polishing and I/A

Single module allows surgeons to toggle intra-operatively between flow

and vacuum modes; flow for sculpting, vacuum for capsule

polishing and I/A

Latest generation vacuum fluidics with StableChamber tubing delivers exceptional accuracy and efficiency for

MICS

Latest generation vacuum fluidics with StableChamber tubing delivers exceptional accuracy and efficiency for

MICS

INFINITITM Vision System

• Tri-modal

– AquaLaseTM

– OzilTM

– Improved

Traditional Ultrasound

• Fluidics

• User Interface

• Ergonomics

Fluidic Management System

• Pump roller interface• Vent valve interface• Irrigation pinch valve• Infusion pressure

membrane• Vacuum Pressure

Sensor• IntrepidTM low

compression tubing

MICS tip and sleeve for 1.8mm surgery with B and L

Stellaris

MICS tip and sleeve for 1.8mm surgery with B and L

Stellaris

• Straight MICS tip• 30 degree bevel• 0.9mm at widest• 0.5mm internal

diameter

• Straight MICS tip• 30 degree bevel• 0.9mm at widest• 0.5mm internal

diameter

Mini-flared tip and Nano sleeve for 1.8mm surgery with

Alcon Infiniti

Mini-flared tip and Nano sleeve for 1.8mm surgery with

Alcon Infiniti

• Curved 45 degree mini-flared tip

• 0.9mm at widest• 0.57mm internal

diameter

• Curved 45 degree mini-flared tip

• 0.9mm at widest• 0.57mm internal

diameter

Stellaris Handpiece -efficient cuttingStellaris Handpiece -efficient cutting

• Increased stroke length for efficient cutting of the nucleus

• Tighter, more focused and consistent delivery of stroke

• CustomControl™ II Software for customisable, programmable wavefront power modulations for all techniques

• Increased stroke length for efficient cutting of the nucleus

• Tighter, more focused and consistent delivery of stroke

• CustomControl™ II Software for customisable, programmable wavefront power modulations for all techniques

OzilTM technologyOzilTM technology

Torsional (side) stroke at tip end (action) -oscillations occur at tip/hub/horn junction -distal end of Kelman tip exhibits a “side to side” displacement due to tip geometryMore Efficient Cutting with 32KHz Torsional induces (“shearing” stress ) vs.

Longitudinal u/s (“compression stress”)

Longitudinal cuts on the “forward” strokeTorsional cuts both “right or left” = efficiency

Torsional (side) stroke at tip end (action) -oscillations occur at tip/hub/horn junction -distal end of Kelman tip exhibits a “side to side” displacement due to tip geometryMore Efficient Cutting with 32KHz Torsional induces (“shearing” stress ) vs.

Longitudinal u/s (“compression stress”)

Longitudinal cuts on the “forward” strokeTorsional cuts both “right or left” = efficiency

Translates = about 1/3 of thermal dissipationTranslates = about 1/3 of thermal dissipation

Now that we have removed the nucleus which IOL can we

use?

Now that we have removed the nucleus which IOL can we

use?

Akreos Microincision LensOptimised for MICS

Akreos Microincision LensOptimised for MICS

Akreos Microincision Lens: Akreos MI60

• Implantable through a 1.8 mm incision using a wound-assisted injection

• Biocompatible hydrophilic material with a proven record of safety, used in 2 million implantations since its introduction in 1998

• The innovative haptic design ensures excellent 3-Dimensional stability of the IOL

Akreos Microincision Lens: Akreos MI60

• Implantable through a 1.8 mm incision using a wound-assisted injection

• Biocompatible hydrophilic material with a proven record of safety, used in 2 million implantations since its introduction in 1998

• The innovative haptic design ensures excellent 3-Dimensional stability of the IOL

AcrySof IQ* Aspheric Natural IOL(Alcon model SN60WF)

AcrySof IQ* Aspheric Natural IOL(Alcon model SN60WF)

• Thinner aspheric optic design for 1.8mm insertion with wound assistance and D-cartridge

• Blue Light-Filtration

• AcrySof Single-Piece Platform

• Low PCO

• Material with 17years track record

• Thinner aspheric optic design for 1.8mm insertion with wound assistance and D-cartridge

• Blue Light-Filtration

• AcrySof Single-Piece Platform

• Low PCO

• Material with 17years track record

*IQ (Image Quality)*IQ (Image Quality)

So how do they really compare?

So how do they really compare?

• Both deliver 1.8mm surgery with early visual rehabilitation due to no induced astigmatism

• Both require specific knives, capsulorhexis forceps, phaco tips and sleeves

• Wound assisted insertion is mandatory• Time will tell how the IOLs perform in the

long term as far as PCO is concerned

• Both deliver 1.8mm surgery with early visual rehabilitation due to no induced astigmatism

• Both require specific knives, capsulorhexis forceps, phaco tips and sleeves

• Wound assisted insertion is mandatory• Time will tell how the IOLs perform in the

long term as far as PCO is concerned

Thank youThank you