Safety and Efficacy of Micro-Incisional Cataract Surgery with Bimanual Phacoemulsification for White Mature Cataract

Abstract

Background: To evaluate the safety and efficacy of micro-incisional cataract surgery (MICS) with bimanual phacoemulsification for the management of white mature cataract. Methods: Twenty-five eyes in 25 patients with mature cataract were prospectively recruited to undergo MICS with bimanual phacoemulsification. Serial changes in best-corrected visual acuity (BCVA), central corneal thickness (CCT) and endothelial cell density (ECD) were compared using the Wilcoxon signed-rank test. Results: MICS was successfully performed in 24 (96%) of the 25 eyes, with 1 eye requiring conversion to extracapsular cataract extraction due to radial tear during continuous curvilinear capsulorhexis. The median preoperative BCVA was hand movement. On day 1 postoperatively, the median BCVA improved to 0.6 (p < 0.001 compared with baseline). All patients had BCVA of 0.6 or better at 3 months after surgery (p < 0.001 compared with baseline). The mean increase in CCT at day 1 and week 1 postoperatively was 11.5 and 7.1%, respectively. The change in mean CCT was no longer significant at month 3 postoperatively (p = 0.82). The mean reduction in ECD at 3 months postoperatively was 7.8% (p = 0.037). None of the patients developed any postoperative complications. Conclusions: MICS with bimanual phacoemulsification appeared to be a promising alterative for the management of white mature cataract.

Phacoemulsification versus manual small-incision cataract surgery for white cataract

“…Table 3 shows the results in other studies that evaluated the safety and efficacy of phacoemulsification in eyes with white cataract. 2,3,[13][14][15][16][17] Although the results seem comparable to those of routine cataract surgery and the visual outcomes excellent, most studies had a small sample size, which calls into question statistical comparisons.…”

Results of Coaxial Phacoemulsification Through a 1.8-mm Microincision in Hard Cataracts

“…The literature confirms our finding that the mean postoperative endothelial cell density loss in the final visit is significantly higher in eyes with hard nuclei. Wong et al 16 examined 25 eyes with white mature cataracts that underwent B-MICS. In their study, the surgery was uneventful in 24 eyes; however, in 1 eye it was necessary to convert to extracapsular cataract extraction.…”

Advances in cataract surgery

“…The phacoemulsification machines have stepped up to this challenge by enhancing the capability of the fluid management (infusion, aspiration and vacuum capabilities termed 'fluidics') and phacoemulsification energy delivery together with improved instrumentation to facilitate more effective MICS. 41 Ultrasonic phacoemulsification is the standard for cataract surgery although laser has been tried but has never really been accepted. 42,43 Instead, research is being focused on refining delivery of existing ultrasonic technology in terms of instrumentation and energy delivery.…”