Microinterventional endocapsular nucleus disassembly: novel technique and results of first-in-human randomised controlled study

Abstract

AimTo assess the safety and efficacy of microinterventional endocapsular nuclear fragmentation in moderate to severe cataracts.MethodsThis was a prospective single-masked multisurgeon interventional randomised controlled trial (ClinicalTrials.gov NCT02843594) where 101 eyes of 101 subjects with grade 3‒4+ nuclear cataracts were randomised to torsional phacoemulsification alone (controls) or torsional phacoemulsification with adjunctive endocapsular nuclear fragmentation using a manual microinterventional nitinol filament loop device (miLOOP group). Outcome measures were phacoemulsification efficiency as measured by ultrasound energy (cumulative dispersed energy (CDE) units) and fluidics requirements (total irrigation fluid used) as well as incidence of intraoperative and postoperative complications.ResultsOnly high-grade advanced cataracts were enrolled with more than 85% of eyes with baseline best corrected visual acuity (BCVA) of 20/200 or worse in either group. Mean CDE was 53% higher in controls (32.8±24.9 vs 21.4±13.1 with miLOOP assistance) (p=0.004). Endothelial cell loss after surgery was low and similar between groups (7‒8%, p=0.561) One-month BCVA averaged 20/27 Snellen in miLOOP eyes and 20/24 in controls. No direct complications were caused by the miLOOP. In two cases, capsular tears occurred during IOL implantation and in all remaining cases during phacoemulsification, with none occurring during the miLOOP nucleus disassembly part of the procedure.ConclusionsMicrointerventional endocapsular fragmentation with the manual, disposable miLOOP device achieved consistent, ultrasound-free, full-thickness nucleus disassembly and significantly improved overall phaco efficiency in advanced cataracts.Trial registration numberNCT02843594

Modified phacoemulsification plus goniosynechialysis compared with conventional surgery for cataract and glaucoma

“…The advantages were effective reduction of ultrasound energy, endothelial damage, and eye stress. Ianchulev et al (20) also reported lower rate of endothelial cell loss caused by combined nucleus fragmentation than by phacoemulsification alone. However, the present study lacks data on endothelial cell detection as this is a retrospective analysis, so further prospective studies or randomized controlled studies to supplement our results are required.…”

“Chopper Shield” Technique to Protect Corneal Endothelium During Phacoemulsification Surgery for Rock Hard Cataracts

“…The prechopping techniques including the miLOOP (Carl Zeiss Meditec, Dublin, USA) technique fragment the hard nucleus into smaller fragments, thereby reducing the phaco time and energy used. 23 However, there are challenges involved in fragmenting the brunescent nucleus into six or eight smaller fragments. Furthermore, the movement of large nuclear fragments in the anterior chamber to cause mechanical trauma to the corneal endothelium still continues.…”

COVID-19 and cataract surgery backlog in Medicare beneficiaries

“… 15 For surgeons who prefer femtosecond laser–assisted cataract surgery, strategies to improve workflow and reduce time such as moving the laser to the operating room or alternatives to laser-assisted capsulotomy such as zepto and miLoop for dense lenses might be of consideration. 16 – 19 Furthermore, same-day sequential cataract surgery might be considered for patients needing bilateral surgery owing to considerations of anisometropia and intended monovision. 20 It might be possible to covert some postoperative visits to telemedicine or to defer them altogether without compromising patient safety.…”