1 / 12

HELVACIOGLU Firat , MD, SENCAN Sadik , MD, OGUZHAN Hasan, MD, YETER Celal, MD

THE OUTCOMES OF MICS WITH CRUISE CONTROL SYSTEM VS MICS WITH WHITESTAR ICE AND CASE SETTINGS IN HARD CATARACTS. HELVACIOGLU Firat , MD, SENCAN Sadik , MD, OGUZHAN Hasan, MD, YETER Celal, MD. Bakirkoy Educat i on And Research Hosp i tal Department Of Ophthalmology , Istanbul TURKEY

hesper
Télécharger la présentation

HELVACIOGLU Firat , MD, SENCAN Sadik , MD, OGUZHAN Hasan, MD, YETER Celal, MD

An Image/Link below is provided (as is) to download presentation Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author. Content is provided to you AS IS for your information and personal use only. Download presentation by click this link. While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server. During download, if you can't get a presentation, the file might be deleted by the publisher.

E N D

Presentation Transcript

  1. THE OUTCOMES OF MICS WITH CRUISE CONTROL SYSTEM VS MICS WITH WHITESTAR ICE AND CASE SETTINGS IN HARD CATARACTS HELVACIOGLU Firat, MD, SENCAN Sadik, MD, OGUZHAN Hasan, MD, YETER Celal, MD BakirkoyEducation And Research HospitalDepartment Of Ophthalmology, Istanbul TURKEY Theauthorshave no financialinterest in thesubectmatter of this poster

  2. PURPOSE • Tocomparethesafetyandefficacy of Whitestar ICE and CASE settingswithcruisecontrolsystem in bimanual MICS. Duet system Micro forceps Divide & Conquer

  3. METHODS • Between January 2006 and March 2008, MICS (G1) was performed in 20 eyes of 18 patients by using the AMO-Sovereign Whitestar surgical systemwiththeaid of cruisecontrolsystem. • MICS (G2) was performed in 20 eyes of 17 patientsby using the AMO-Sovereign Whitestar surgical systemwith ICE and CASE settings. • Patients were chosen according to their nuclei hardness (grade3-4). • Patients were examined for: • intraoperative complications, • Mean phaco time • Total phaco % • EPT • % endothelial cell loss • postoperative corneal edema and • anterior chamber reactions.

  4. METHODS • Phaco1 – Grooving • AspirationVaccum WhiteStar • Unoccluded& 22cc/min.50 mmHg30%-50% • OccludedLinear PanelLinear • Phaco2 – Chopping • Aspiration Vaccum WhiteStar • Unoccluded& 28cc/min.350 mmHg30%-50% • OccludedLinearLinearLinear • C/F (33%) Operationcycleused in bothgroups • ICE 1 ms/constantkick • CASE vaccum200 mmHG

  5. ENERGY PARAMETERS AND ENDOTHELIAL CELL LOSSES MICS + CRUISE CONTROL • Mean EPT (seconds): • 3.75 (SD 1.18) • Mean US time (min.): • 1.45 (SD 0.18) • Mean total phaco %: • 5.1 (SD 1.3) MICS + ICE&CASE • Mean EPT (seconds): • 3.22 (SD 1.38) • Mean US time (min.): • 1.24 (SD 0.22) • Mean total phaco %: • 4.8 (SD 1.1)

  6. There was not any complication affecting the visual outcome in both groups. There was not any statistical significance between the groups in the values of the; endothelial cell loss the EPT the rate of intraoperative complications, the grade of postoperative corneal edemaand anterior chamber reactions No corneal burn was seen and both types of operations were performed safely and efficiently in hard cataracts. RESULTS

  7. POSTOPERATIVE CORNEAL EDEMA AND ANTERIOR CHAMBERREACTIONS PostoperativeCornealEdemaPostoperativeAnteriorChamberReactions

  8. DISCUSSION • MICS has many advantages; • Switch incisions, create space and manipulate lens fragments with irrigation, • Irrigate without pushing the lens fragments away from the aspiration tip, • Increase safety, less turbulent and more stable anterior chamber, • Improved control on hydrodissection and capsulorhexsis, • less risk of leakage, theoretically reduced risk of endophthalmitis, • accelerate visual rehabilitation, astigmatically neutral ( <1.5 mm) • Main limiting factors (1); • The limits in IOL technology (this field continues to grow rapidly), • the narrow lumens of the irrigating choppers that limits the max vacuum levels (Both ICE and CASE systemsandCruise Control system allows us to use higher vacuum settings by controlling post occlusion surges 2) • the increase risk of corneal burn (3), (The risk is low if the phaco device and the settings were appropriate for this surgery) • The safety and efficacy of bimanual MICS increases by the aid of cruise control system which provides higher vacuum, less US energy and less turbulance. Fine H, Hoffman RS, Packer M. Optimizingrefractive lens exchangewithbimanualmicroincisiionphacoemulsification. J CataractRefractiveSurg 2004; 30:550-554 Chang D.F. 400 mmHghighvacuumbimanualphacoattainablewithStaarCruiseControl device. J CataractRefractiveSurg 2004; 30:932-933 William Soscia et all. MicrophacoemulsificationwithWhitestar, A woundtemperaturestudy. J CataractRefractiveSurg 2002; 28:1044-1046

  9. DISCUSSION • The Cruise Control was designed to reduce postocclusion surge with standard phaco instrumentation. However, its ideal application is with bimanual phaco, in which more limited irrigation inflow has otherwise prevented the safe use of high vacuum settings from surge. • The device consists of a 2 cm flow-restricting segment with a 0.3 mm internal lumen. It is positioned behind a mesh filter that traps emulsified nuclear material before it can clog the flow restrictor. • 400 mm Hg high-vacuum bimanual phaco attainable with this device. (1) • Up to 300 mm Hg vacuum was used in G 1, the operations performed safely without any complication. Chang DF. Correspondance. 400 mm Hg High-Vacuum Bimanual Phaco Attainable with the Staar Cruise Control Device. 2004;30(4):932-933

  10. WHITESTAR ICE AND CASE TECHNOLOGY DISCUSSION • Kickseperatesnucleusfromphaco tip andcreates a microspacethusincreasecavitation • CASE is an occlusionmodetechnologywhichsensesocclusionbreaks, reversesthepumpingsystemwithin 26 milisecondsthusdecreasesthe risk of surgeandanteriorcahmberinsatbility in highvaccumsettings

  11. DISCUSSION • In recent years, damage to corneal endothelial cells during cataract extraction has been minimized as a result of better instrumentation, newer viscoelastic materials, and improved surgical techniques which aims to reduce phaco time (1). • Studies report endothelial cell loss rates from 4% to 15% after phacoemulsification by experienced surgeons (2,3) • The 5.7% and 5.2% of mean endothelial cell losses demonstrated the safety of the surgeries performed in hard cataracts.Bothsystemsgive us toabilitytoperform MICS in hard cataracts Holzer MP, Tetz MR, Auffarth GU, et al. Effect of Healon5 and 4 other viscoelastic substances on intraocular pressure and endothelium after cataract surgery. J Cataract Refract Surg. 2001;27:213-218 Kosrirukvongs P, Slade SG, Berkeley RG. Corneal endothelial changes after divide and conquer versus chip and flip phacoemulsification. J Cataract Refract Surg. 1997;23:1006-1012 Zetterström C, Laurell C-G. Comparison of endothelial cell loss and phacoemulsification energy during endocapsular phacoemulsification surgery. J Cataract Refract Surg. 1995;21:55-58

  12. CONCLUSIONS • TheCruiseControl device gives us theabilitytoperform MICS withhighervacuumsettingswithoutaffectingthesafety of theoperations. • Modern phacosystemsgive us theabilitytousesleeveless, barephacotipsfromverysmallcornealincisions. • Bytheaid of ICE and CASE settings, it is possibletousehighervacuumsettingsandless US powerwithoutcruisecontrolsystem.

More Related