الفهرس 
AbstractOnly 14 pages are availabe for public view
 |  | from | 188 |  |  |
| | | from | 188 | | |
Abstract
Cataract surgeons continue to invent novel technologies that increase efficiency, safety and surgical outcomes. Two techniques, bi-axial microphacoemulsification (B-MICS) and micro-coaxial phacoemulsification (C-MICS), have permitted surgeons to operate via smaller incisions. B-MICS requires two small incisions (1.0-1.4 mm) in length and utilizes a fine phaco tip without silicon sleeve. One incision is used for irrigation and chopping, and the second incision is used for ultrasound and aspiration. In C-MICS surgical approach, a main incision of 2.2mm in length is used to perform ultrasound, irrigation, and aspiration using sleeved phaco tip. Purpose: This study compared the efficacy and safety outcomes of bimanual microincision cataract surgery (B-MICS) versus 2.2-mm coaxial phacoemulsification using phaco technology of torsional ultrasound. Methods: This prospective, randomized, observational, comparative case series comprised 60 cataractous eyes with nuclear or corticonuclear cataract (grades 1 to 4 on the Lens Opacities) were randomly selected to have cataract extraction using 1 of 2 techniques: the standard coaxial small incision (C-SICS) technique with 2.2-mm principal incision (30 patients) and bimanual MICS (B-MICS) technique with two 1-mm incisions (30 patients) using Infiniti phacoemulsification system with Alcon Ozil handpiece and all eyes were implanted with an aspheric microincision intraocular lens (IOL). The 1.2-mm B-MICS incision was widened to 1.8 mm for IOL insertion. (Akreos® AO monofocal IOL, BAUSCH & LOMB Micro incision IOL). The main outcomes measures were ultrasound power, effective phacoemulsification time, the mean estimated fluid use, and total surgical time, postoperative best-corrected visual acuity (BCVA), surgically induced astigmatism (SIA), higher-order aberrations, endothelial cell loss (ECL), central corneal thickness (CCT), and complications during and after surgery. Follow up was 1 day, 1 week, 1 month, and 3 months after surgery. Results: The Mean Total surgical time was statistically significant higher in B-MICS group B 10.09 min ±0.5 than Co-axial group A 7.6 min ±1.2 (P < 0.001). The Mean Estimated fluid used higher in C-SICS group A 66.5ml than B-MICS group B 61.5ml (P < 0.07). The others studied Phaco parameters including Mean Phaco time, Mean Phaco Power; Mean EPT & Mean US Time were higher in group A than group B, although there was no statistically significant between each groups. There was no statistically significant difference between the postoperative best-corrected visual acuity (BCVA) of both groups throughout the postoperative period. Visual rehabilitation in the B-MICS group was faster at 1 day than C-SICS patients (non-significant). The Mean CCT for the 30 eyes in the C-SICS was 522.5µ ± 23.1 preoperatively & statistically significant increased postoperatively to 537.4 µ ± 34.9 (P<0.001). The Mean CCT for the 30 eyes in the B-MICS was 525.8 µ ± 23.3 preoperatively & showing non-significant changes postoperatively 526.4 µ ±26.8 (P<0.7). The mean CCT change was significantly higher in group (A) than in group (B), p= 0.01. There was statistically deference between the two groups regarding the CCT changes, the B-MICS (group B) showed statistically significant less CCT changes than the C-MICS (group A) p=0.001. The Mean Endothelial cell loss was higher among group A (221.2 ± 44.1) compared to group B (167.5 ± 67.9) with statistically significant difference (p<0.001). At 3 months, surgically induced astigmatism (SIA) was significantly lower with B-MICS 0.8D (0.2-2.2) than C-SICS 1.15D (0.5-4.4); P=0.001. There was no difference between the two groups regarding the complications. Conclusion B-MICS and C-MICS phacoemulsification techniques achieved excellent safety and efficient outcomes. B-MICS showed earlier improvement in best corrected visual acuity (BCVA), less surgically induced astigmatism (SIA), less endothelial cell loss (ECL), less central corneal thickness (CCT) changes and less all the phaco parameters used during the surgery.