Mechanical micro-interventional lens fragmentation using a proprietary device (miLoop, Iantech) has the potential to improve phacoemulsification efficiency, control, and safety in all cataract surgery, and particularly for the challenging cases that involve very dense nuclei, said William F. Wiley, MD.
“Cataract surgeons are always looking to become more efficient in the operating room, and over the years, a lot of new hardware has been introduced to reduce the ultrasound energy requirement and complications,” said Dr. Wiley, medical director, Cleveland Eye Clinic, Cleveland, OH. “Yet, I sometimes wonder if these tools really made us better or more efficient surgeons.”
Micro-interventional lens fragmentation with the device is an elegant and energy-free technique for endocapsular lens fragmentation, Dr. Wiley noted.
“In routine cases, it can help with the most important step of nucleus disassembly as well as cortical release,” he said. “In more advanced cases, it can reduce phaco energy utilization—substituting heat-producing emulsification for energy-free micro-interventional disassembly.”
Since the approach is not introducing energy in the eye and is independent of cataract grade, it can dramatically inflect the curve of surgical efficiency, Dr. Wiley said.
The device represents an extension of other micro-interventional concepts in ophthalmology, said Sean Ianchulev, MD, MPH, who developed the device.
“Through our experience in microinvasive glaucoma surgery, we realized that some of the techniques being used in cardiovascular surgery and interventional radiology were quite pertinent to ophthalmology,” Dr. Ianchulev, founder of Iantech and professor of ophthalmology, Icahn School of Medicine at Mt. Sinai, New York, NY. “The hope is to take their expression further to create better tools that can guide us toward breaking new grounds in our surgical approach.”
Phaco has served ophthalmology well in the past 50 years, but ophthalmologists are on the plateau of its technology maturation curve.
“Our patients demand ever less traumatic and minimally invasive solutions for immediate refractive outcomes,” Dr. Ianchulev said.