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Comparison of 1.8 coaxial microincision cataract surgery and standard 2.2 coaxial phacoemulsification in terms of endothelial cell loss in patients with shallow anterior chamber

Session Details

Session Title: Subluxed IOLs and Scleral Fixation

Session Date/Time: Wednesday 09/10/2013 | 08:00-10:30

Paper Time: 10:13

Venue: E102 (First Floor)

First Author: : I.Iliescu ROMANIA

Co Author(s): :    O. Moraru              

Abstract Details

Purpose:

To assess the safety of the 1.8 Coaxial Microincision Cataract Surgery (CMICS) technique compared to the Standard 2.2 Coaxial Phacoemulsification in terms of endothelial cell loss in patients with shallow anterior chamber(AC), where the ultrasound (US) energy is delivered closer to the endothelium. Measuring the intraoperative corneal endothelial cell loss would be an indirect evaluation of the differences in the AC turbulence (due to different fluidics) during the surgery in both cases.

Setting:

Oculus Eye Clinic – Bucharest, Romania

Methods:

This prospective cohort consisted of 20 eyes with medium or advanced cataract and shallow AC, less than 2.9 mm (measured with IOL Master-Zeiss and Ocu Scan-Alcon). In all cases cataract surgery was performed using Stellaris PC Vision Enhancement System. The first 8 eyes were operated using the 1.8 CMICS technique and the other 12 eyes were operated using a standard 2.2mm incision. Endothelial cell count was performed in all eyes, before surgery and one month after surgery using Topcon Specular Microscope SP 3000P. Both groups comprised eyes with similar endothelial cell count (over 2000 cells/mm²) and morphology, similar cataracts and similar amount of ultrasound energy used during phacoemulsification. All surgeries were performed by the same surgeon, with the same phaco machine, the same surgical technique (quick chop), and the same vascoelastic. We excluded cases with intraoperative complications or other concomitant ocular pathology.

Results:

Medium endothelial cell loss was 5,21% for patients operated with 1.8 CMICS technique (0,11%- 20,33%) and the medium endothelial cell loss for patients operated using the standard 2.2mm coaxial technique was 15,57% (4,41%-28,42%). The medium endothelial cell loss is 3 times lower in the 1.8 CMICS group compared to the 2.2 Phaco technique group, which is statistical significant (p<0,001).

Conclusions:

Our results show that the 1.8 CMICS technique using Stellaris PC Vision Enhancement System with its particular fluidics paramethers is a safe phacoemulsification technique for corneal integrity, even in eyes with small AC, where the US energy is delivered closer to the endothelium. Moreover, the 1.8 CMICS technique seems to have an even higher safety profile compared to the standard 2.2 phaco technique, probably due to lower AC turbulence caused by lower vacuum and a closed fluidics system. Since our data is obtained from a small group of patients, we need further evaluation to confirm our results on larger groups in order to be able to make a recommendation for 1.8 CMICS as standard technique in eyes with shallow AC. A thorough evaluation may be interesting for eyes with shallow AC and low endothelial cell number (under 2000/mm²).

Financial Interest:

... travel has been funded, fully or partially, by a company producing, developing or supplying the product or procedure presented