Jorge L. Alio MD PhD Ma. Cecilia C. Agdeppa MD VISSUM-Instituto Oftalmologico de Alicante ASCRS Convention 2010 Boston

1. Efficiency of MicroIncision Cataract Surgery using comprehensive MICS in Different Cataract Densities Jorge L. Alio MD PhD Ma. Cecilia C. Agdeppa MD VISSUM-Instituto Oftalmologico de Alicante ASCRS Convention 2010 Boston Financial DisclosureProf. Jorge L. Alió MD, PhD. • D AcuFocus • A-D Akkolens • D Alcon Laboratories • A-D Bausch&Lomb • D Carl Zeiss Meditec • D Chemedica • A Eyemaginations • P Index Instruments • D IntraLase Corporation A Mediphacos D Novagali Pharma D-P Nulens A Ocular Surgery News/Slac A-D Oculentis A Presbia D-E Schwind eye-tech-solution P Springer Verlag P Tekia D Thea

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 90o to 110o 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. Results 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.