Refractive Lens Surgery

206 J.L. Alio · A. Galal · J.-L.R. Prats, et al.
Table 21.4. Comparison of mean surgical time and saline consumption between the two groups
21.3.4.2 Group II
Twenty eyes (11 patients) operated with
MICS were compared to 20 eyes (13 patients)
operated with phacoemulsification. The eyes
included in this group provided data about
astigmatic changes and saline consumption,
which were compared between the two techniques.
1. Astigmatic changes: using vector analysis
to detect the postoperative changes in
astigmatism:
(a) MICS group:
(i) Seventeen eyes had a change of ≤0.5 D
(ii) Three eyes had a change ranging between
1 and 0.5 D
(b) Phacoemulsification group:
(i) Four eyes had a change of ≤0.5 D
(ii) Six eyes had a change ranging between
0.5 and 1.0 D
(iii) Ten eyes had a change of more than 1 D
2. Saline consumption and pachymetry: the
differences between the two groups are
illustrated in Tables 21.3 and 21.4.
21.4 Advantages of MICS
Performing small incisions in cataract surgery
has a number of theoretical advantages:
1. Fast visual recovery and improved visual
outcome
2. Decrease in postoperative astigmatism
3. Reduction in the anatomical healing time
4. Fewer complications
5. IOL insertion through microincisions is
now possible
6. Reduction in the operating time
MICS Phacoemulsification p value
Mean surgical time 4.4 (1.67 SD) 3.13 (2.29 SD) 0.121
Mean saline consumption 92.77 (34.52 SD) 113.84 (30.96 SD) 0.198
MICS can be performed using laser energy,
which is as safe as ultrasound energy. The use
of either source of energy permits:
1. Visual acuity improvement on the first
postoperative day
2. Reduction of the inflammatory reaction
postoperatively
3. Lower percent of in endothelial cell loss
Improving both techniques will open the way
to emulsification of all grades of nucleus density;
this could be achieved by improving the
safety and the fluidity of the low-ultrasound
phacoemulsification and laser, with the possibility
of obtaining greater aspiration and
more vacuum that helps to maintain continuous
contact between the crystalline lens to be
removed and the laser aperture.
21.5 Conclusions
Microincision cataract surgery today is becoming
a popular technique in crystalline
lens surgery. With the new developing technology
of phacoemulsification machines and
power settings, together with adequate
instruments, all the cataract grades are
amenable to MICS. Refractive lens exchange
using the MICS technique has the advantage
of preventing induced astigmatism and
wound complications.