Novel lens and phaco platform make for ideal partners

May 15, 2008

A microincisional lens (Akreos MI60, Bausch & Lomb) can be implanted through a 1.8-mm incision. Although not yet available in the United States, excellent results have been achieved with the IOL internationally. Surgeons can use it after biaxial or coaxial microincisional phacoemulsification with an integrated phaco platform (Stellaris Vision Enhancement System, Bausch & Lomb) to provide patients with the benefits of less invasive surgery.

Key Points

Chicago-International experience demonstrates excellent results are being achieved with a microincision (Akreos MI60, Bausch & Lomb), a novel implant able to be inserted through an unenlarged, 1.8-mm incision, said Louis "Skip" Nichamin, MD, at the annual meeting of the American Society of Cataract and Refractive Surgery.

"With more than 1 year of follow-up available, the . . . IOL has been shown to be safe and effective with excellent outcomes for visual acuity, low rates of posterior capsule opacification development, and outstanding intracapsular stability," said Dr. Nichamin, Laurel Eye Clinic, Brookville, PA.

"With the [IOL] and the [integrated phacoemulsification platform (Stellaris Vision Enhancement System, Bausch & Lomb)], Bausch & Lomb [B&L] has worked hard to bring forth a true microincisional cataract surgery [MICS] platform. Since 2007, I and other U.S. surgeons have been able to take advantage of the groundbreaking phacoemulsification technology. We continue to look forward to the availability of the [lens] as the missing link for providing American patients with the full benefits of MICS."

"This is not the hydrophilic acrylic that surgeons knew from the Hydroview days. Problems with primary opacification have been eliminated, and its refractive index, 1.46, is slightly lower than that of hydrophobic materials, which ostensibly may lead to better vision, especially with regard to dysphotopsias," said Dr. Nichamin.

The lens is very thin and flexible, yet a very robust lens with high structural integrity compared with other "thin" lenses developed for microincision surgery, he added. After folding and injection through a microcartridge, it readily recovers its shape, Dr. Nichamin said.

The haptic design is a particularly distinctive feature of the IOL, he said. It was specifically engineered to absorb forces from capsular fibrotic changes in three dimensions and direct these destabilizing forces away from the optic so that the optic would remain stable with regard to both centration and antero-postero migration, therefore ensuring a stable refractive result. Clinical experience shows the design is accomplishing its goals, Dr. Nichamin said.

The integrated phaco platform was designed from the ground up as a brand new platform that could be used for MICS through either the biaxial or microcoaxial routes. Describing its features, Dr. Nichamin noted that his system of choice has the option of using a vacuum- or flow-based pump and features a new ergonomic handpiece. It retains the dual linear foot pedal of its predecessor but offers optional wireless foot pedal control.

Dr. Nichamin said he is using the integrated phaco platform to perform coaxial MICS through a 1.8-mm incision in all of his lens-extraction procedures.

"MICS is a less invasive procedure, so the eyes look better sooner and heal faster," he said.

The smaller incision size also affords better vision because it minimizes induced astigmatism, Dr. Nichamin said. Research conducted by Jorge Alio, MD, PhD, indicates that MICS induces no appreciable aberrations.

"These benefits aside, performing phaco through the small, 1.8-mm incision lends more control for better intraoperative safety," Dr. Nichamin said.