1. J. E. “Jay” McDonald, II M.D. McDonald Eye Associates Fayetteville, Arkansas www.mcdonaldeye.com Financial disclosure: Bausch and Lomb – Consultant; Addition Technology - Advisory Board; Santen - Research Support; Acufocus - Research Support; Alcon Pharmacology - Speaker Bureau; Wave Tec – Research Support; Inspire – Consultant; Revitalvision, Inc. - Advisory Board

2. Coaxial Microincision Cataract Surgery (MICS)  The trend in cataract surgery is toward smaller incisions  Coaxial MICS (C-MICS) Use current phaco technique Reduce surgically induced astigmatism (SIA) 1-3 Increase wound sealability 4 Reduce endothelial cell loss 5 1.Heg Wee Jin. WOC 2008, Hong Kong. 2.Braga-Mele R. ASCRS in San Francisco, CA, April, 2009. 3.Barrett GD. APAO Congress. Bali, Indonesia, May, 2009. 4.Barrett GD, Carlsson A. Canadian Ophthalmological Society, Montreal, Canada, June, 2007. 5.Zafirakis P. ASCRS in San Francisco, CA, April, 2009.

3. Complete MICS System  Stellaris system for 1.8 mm phaco  Akreos MICS IOL implantable through 1.8 mm incision

4. Stellaris 1.8 Coaxial MICS  Only system designed for coaxial 1.8 mm microincision cataract surgery (C-MICS)  Easy transition from small-incision to microincision surgery  StableChamber fluidics enhances followability, holdability and chamber stability 1.8 mm C-MICS (22 gauge) 2.8 mm SICS (19 gauge)

5. 5 Akreos MICS IOL  Akreos MICS lens inserts through 1.8 mm phaco incision 30% thinner than Akreos AO lens Aspheric aberration-free optic Moderate refractive index 360° posterior square-edge design

6. Study  Retrospective chart review  All procedures by same surgeon in same OR  Millenium small incision cataract surgery (SICS) 2.8 mm (n=45) Eyes implanted with SofPort AO or Crystalens IOL  Stellaris 1.8 mm MICS (n=63) Eyes implanted with Akreos MICS IOL  EPT, cataract density assessed perioperatively  Flare/cells assessed 3.5-5.0 hours postop Trace=0.5, 1=1.0, 1+-1.5, 2=2.0, 2+=2.5  Uncorrected and best-corrected distance visual acuity at 3 and 6 months Some eyes targeted for monovision; measured uncorrected and best-corrected near VA at 3 and 6 months

7. Results SICSMICSP-value Cataract Density 2.122.15 0.7745 EPT3.940.7851 Cells/Flare1.781.260.0001

8. Mean Distance Visual Acuity 3M UCVA 3M BCVA 6M UCVA 6M BCVA 2.8 mm SICS 20/3420/2520/2620/24 1.8 mm MICS 20/2720/2120/2520/21

9. 3 Month Distance Visual Acuity

10. 6 Month Distance Visual Acuity

11. Conclusion  Microincision cataract surgery results in a quieter postoperative eye than small incision cataract surgery  Minimizing incision size in cataract surgery may also: Decrease surgically induced astigmatism Improves wound strength and integrity Reduces endothelial cell loss Reduce postoperative endophthalmitis Reduce patient recovery time