1. Microcoaxial phaco using 1
Microcoaxial phaco using 1.8mm incisions: comparison of two machines and IOL systems
Richard Packard Windsor England
Consultant for Alcon, AMO and Bausch and Lomb

2. 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!

3. 3.2mm mm mm mm

4. 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

5. What 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

6. Incisions for 1.8mm C-MICS

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

8. 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

9. Stellaris EQ Fluidics Management Technology
EQualising aspiration and irrigation for unsurpassed safety, efficiency and predictability in either flow or vacuum modes for solid chamber stability throughout the procedure EQ
Advanced Flow
Module (AFM) EQ
Vacuum Fluidics Module (VFM)
AFM is Advanced Flow Module - for Flow or Vacuum characteristics; VFM is Vacuum fluidics module
Dr. Lindstrom – EQ Fluidics stands for B&L brand of fluidics technology. It stands for Equal, as in equal or balanced control of flow and aspiration.
In the system, EQ Fluidics refers to both vacuum and flow/vacuum modules.
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

10. INFINITITM Vision System
Tri-modal
AquaLaseTM
OzilTM
Improved Traditional Ultrasound
Fluidics
User Interface
Ergonomics

11. Fluidic Management System
Pump roller interface
Vent valve interface
Irrigation pinch valve
Infusion pressure membrane
Vacuum Pressure Sensor
IntrepidTM low compression tubing

12. 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

13. 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

14. Stellaris 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

15. Translates = about 1/3 of thermal dissipation
OzilTM 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 geometry
More Efficient Cutting with 32KHz
Torsional induces (“shearing” stress )
vs.
Longitudinal u/s (“compression stress”)
Longitudinal cuts on the “forward” stroke
Torsional cuts both “right or left” = efficiency
Translates = about 1/3 of thermal dissipation

16. Now that we have removed the nucleus which IOL can we use?

17. Akreos Microincision Lens Optimised 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

18. 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
*IQ (Image Quality)

19. 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

20. Thank you