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
ASCRS JL Febbraro MD

3. Materials & Methods 48 eyes 1.8 mm S-MICS on steep axis
Topical anesthesia
Hydrophilic acrylic IOL
Wound assisted injection
ASCRS JL Febbraro MD

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

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% > 20/40 by 3 days po.
ASCRS JL Febbraro MD

6. Results Keratometric astigmatism Pre and postoperative keratometry
S-MICS n:48
Mean Preop Astig.
Mean Postop Astig
K2-K1
0.59 +/- 0,35 D
0,65 +/- 0,35 D
S-MICS n:48 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
ASCRS JL Febbraro MD

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.
ASCRS JL Febbraro MD

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.
ASCRS JL Febbraro MD

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.
ASCRS JL Febbraro MD

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.
ASCRS JL Febbraro MD

11. References
Ernest P.H., Lavery K.T., Kiessling L.A. Relative Strength of Scleral Corneal Incisions Constructed in Cadavers Eyes. J Cataract Refract Surg. 1994;20:84-88
Ernest P.H., Neuhann T. Posterior Limbal Incision. J Cataract Refract Surg. 1996;22:78-84
Ernest P.H. et al. Is There a Difference in Incision Healing Based on Location? J Cataract Refract Surg. 1998;24:
Alio JL et al. Outcomes of Microincision Cataract Surgery Versus Coaxial Phacoemulsification. Ophthalmology. 2005;112:
Alio JL et al. Visual Outcomes of Microincision Cataract with Implantation of Acry Smart Lens. J Cataract Refract Surg. 2005;31:
ASCRS JL Febbraro MD