1. Comparison of two differents ultrasound mode in BMICS technique : Pulse and Continuous US Danielle DEIDIER M.D. Clinique Saint Vincent Toulon - France The author of this poster have received travel expense reimbursement from Bausch+Lomb from Bausch+Lomb ASCRS 2011 San Diego

2. PURPOSE To compare the ultrasound mode Pulse and the ultrasound mode Continuous in term of safety and efficiency during a bimanual micro incision cataract surgery

3. METHODS ► Prospective study ► Same surgeon ► Stellaris™ system (Bausch + Lomb) ► Bimanual MICS (2 incisions of 1.3mm) ► Handpiece 28,5Khz ► 90 patients (90 eyes) ► Two groups : ► Group 1 : 45 patients, US mode Pulse ► Group 2 : 45 patients, US mode Continuous.

4. CRITERIA ANALYSED ► Cornea edema post op D1 ► Complication during surgery (capsular rupture) ► Endothelial cells loss ► UCVA and BCVA ► EPT (effective phaco time) ► APT (average phaco time) ► Phacoemulsification time ► Sealing of incision site at D1 – D8 ► Nucleus density : grade 2, 3 or 4 ► Balanced salt solution volume used during surgery

5. NUCLEUS HARDNESS ► Group 1 (US pulses) :  Mean: 2,6 ± 0,3P=0,15 ns ► Group 2 (US continuous) :  Mean: 2,7 ± 0,4 RESULTS Groups were comparable

6. RESULTS ► As expected, US delivery was higher with the US continuous mode 0 20 40 60 80 100 120 140 160 APT (sec) p=0,0001 CONTINOUS US PULSE 0 5 10 15 20 25 sec EPT (sec) p= 0,0006 CONTINOUS US PULSE 0 2,5 5 7,5 10 12,5 15 17,5 20 22,5 % US % p=0,003 CONTINOUS US PULSE 72,5 46 9,1 11,9 4,6 9,2

7. CORNEA EDEMA Post op D1 ► Group 1 (US pulses):  2 edemas moderate ► Group 2 (US continuous):  1 edema moderate INCISION LEAKAGE D1 & D8 ► In both group, no leak at the incision at D1 and D8. RESULTS BSS VOLUME ► Group 1 ( US pulses):  BSS(ml): 39 ± 10,3 ► Group 2 ( US continuous):  BSS(ml): 37 ± 6,3 COMPLICATION DURING SURGERY Group 1 (US pulses) : Nothing to report Group 2 (US continuous) : Nothing to report P=0,25 ns

8. RESULTS Endothelial cell loss p=0,36 ns There was no statiscally significant difference between both groups

9. P=0,002RESULTS 20/80 20/63 20/50 20/40 20/32 20/25 20/20 20/25 20/32 20/40 20/50 20/63 20/80 P=0,0001 Distinction between both group, UDVA & CDVA is not clinically significant.

10. IN SUMMARY ► As expected the US delivery is more important in group 2 (US continuous) ► In both group:  No complication during surgery  2 moderate edemas in group 1, 1 moderate edemas in group 2  Incisions are tight at D1 & D8  No statiscally significant difference between both group for endothelial cell loss  Distinction between both group in term of UDVA & CDVA are not clinically significant  BSS volume used is equivalent

11. CONCLUSION ► Despite a higher US delivery in continuous mode (Mean US 72,5%) compare to pulse mode (Mean US 46%), we observed that a low frequency handpiece (28,5Khz) with Stellaris™system allow an efficent and secure surgery in BMICS. ► Consequently the continuous US mode is safe and can be used in several cases as challenging cases or hard nucleus.