1. Jorge L. Alio MD PhD Ma. Cecilia C. Agdeppa MD VISSUM-Instituto Oftalmologico de Alicante ASCRS Convention 2010 Boston Efficiency of MicroIncision Cataract Surgery using comprehensive MICS in Different Cataract Densities Financial Disclosure Prof. Jorge L. Alió MD, PhD.  DAcuFocus  A-DAkkolens  DAlcon Laboratories  A-DBausch&Lomb  DCarl Zeiss Meditec  DChemedica  AEyemaginations  PIndex Instruments  DIntraLase Corporation AMediphacos DNovagali Pharma D-PNulens AOcular Surgery News/Slac A-DOculentis APresbia D-ESchwind eye-tech-solution PSpringer Verlag PTekia DThea

2. Introduction  Rapid evolution of cataract surgery due to development of newer, better, more sophisticated technologies and surgical techniques  Leading the forefront is MICS and phaco systems best suited for microincision surgeries such as the Stellaris Vision Enhancement system

3. Purpose of the Study  To evaluate the efficiency of microincision cataract surgery (MICS) using the Stellaris Vision Enhancement System in different cataract densities

4. Study Design and Patients  Non Randomized Descriptive Study  109 eyes of 65 patients  All patients underwent MICS using the Bausch&Lomb Stellaris Phacoemulsification System  Visually significant based on the LOCS scale

5. Inclusion and Exclusion Criteria  Inclusion Criteria  age 40 years to 90 years  no history of ocular surgery  non-diseased cornea and normal fundus examination  Exclusion Criteria  eyes with more than 3.00 diopters (D) of astigmatism  previous corneal and refractive surgeries  those who had history of ocular disease

6. MICS Steps  A dominant incision was made in the positive meridian of the astigmatism approximately 1.2mm wide internally and 1.4mm externally  A sideport incision using the same knife was placed 90 o to 110 o from the main incision.  Anesthesia was achieved by injecting 1% lidocaine into the anterior chamber.  Pupillary dilation was obtained with intracameral mydriatics using phenylephrine 10.0% and tropicamide 10%.  A dispersive ophthalmic viscosurgical device (OVD) was instilled to fill the anterior chamber  Capsulorrhexis of approximately 5.5mm was made using the 23-gauge Alió MICS Capsulorrhexis Forceps (Katena, Inc)  Adequate hydrodissection was done  Prechopping was done.  Phacoemulsification was achieved using the Stellaris Vision Enhancement System (Bausch & Lomb).

7. Stellaris Phacoemulsification System  Improvement and innovation in phacoemulsification technology  Advanced Flow Module (EQ Fluidics)  Enhanced followability and aspiration control  Minimum post-occlusion surge  Rapid return to solid state  Stable Chamber Pack  Micro-mesh filter system with reduced diameter tubing  Provides greater holding power at low flow rates even at higher vacuum levels

8. Stellaris Phacoemulsification System  Custom Control Software II  Permits millisecond range modulation ultrasound control  Variable duty cycle application of 28.5kHz ultrasound for optimized cavitation and rapid emulsification  Ergonomic Design  New six-crystal ergonomic handpiece for optimized cutting and cavitation  Bluetooth wireless dual linear foot pedal

9. Results  Patient Characteristics  109 eyes of 65 patients  42 (65%) females, 23 (35%) males  Mean Age 69 years (range 40-93 years)

10. Results

11. Mean Vacuum Phaco Power (%) APT 1 EPT 2 LOCS I381.82±29.930.36%0.0062±0.00770 LOCS II361.2±61.861.08%0.16±0.140.003±0.002 LOCS III356.46±64.651.5%0.30±0.250.0071±0.0064 LOCS IV365.79±66.782.21%0.96±0.810.021±0.02 LOCS V391.67±20.413.5%2.36±1.560.067±0.04 1 APT: Average Phaco Time 2 EPT: Effective Phaco Time Burst Duration: 20 pulses per second Duty Cycle: 60%

12. Conclusion  MICS with the Stellaris Vision Enhancement System is possible in all cataract densities with minimal use of phaco power (max 3.5% for grade 5 cataract) and very low phacoemulsification time allowing excellent efficiency of the surgery as manifested by the low EPT found in all cataract groups.