Microincision Cataract Surgery with a Scleral Approach

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Microincision Cataract Surgery with a Scleral
Approach

• Jean Luc Febbraro MD
• Marlene Ostendorff MD
• Damien Gatinel MD
• Rothschild Foundation
• Paris
• France

No financial interest
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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
•  

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Materials Methods

• 48 eyes
• 1.8 mm S-MICS on steep axis
• Topical anesthesia
• Hydrophilic acrylic IOL
• Wound assisted injection

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Materials Methods

• S-MICS
• Location
• 1.5 to 2 mm behind the limbus
• Conjunctival miniperitomy (gt2mm)
• Two plane square incision
• Size
• 1,8 x 1,8 mm
• Scleral tunnel
• Knife
• Trapezoidal 1.6 X 1.8 mm metal blade

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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 gt 20/40 by 3 days po.

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Results

• Keratometric astigmatism
• Pre and postoperative keratometry

S-MICS n48 Mean Preop Astig. Mean Postop Astig
K2-K1 0.59 /- 0,35 D 0,65 /- 0,35 D
S-MICS n48 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
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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.

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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.

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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.

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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.

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References

1. Ernest P.H., Lavery K.T., Kiessling L.A. Relative
   Strength of Scleral Corneal Incisions Constructed
   in Cadavers Eyes. J Cataract Refract Surg.
   19942084-88
2. Ernest P.H., Neuhann T. Posterior Limbal
   Incision. J Cataract Refract Surg. 19962278-84
3. Ernest P.H. et al. Is There a Difference in
   Incision Healing Based on Location? J Cataract
   Refract Surg. 199824482-486
4. Alio JL et al. Outcomes of Microincision Cataract
   Surgery Versus Coaxial Phacoemulsification.
   Ophthalmology. 20051121997-2003
5. Alio JL et al. Visual Outcomes of Microincision
   Cataract with Implantation of Acry Smart Lens. J
   Cataract Refract Surg. 2005311549-1556