I i i I i i i d ti i d ti Incision Incision size reduction size reduction

Transition from coaxial phaco to Bi manual phaco is : Transition from coaxial phaco to Bi-manual phaco is :
True transition, Lot of advantages:
Less wound size allover the surgery g y
Workingthrough1 8mmincision Workingthrough1.8mmincision
allofthetime.
IOLinsertionfromanysiteneededwith
NOSURGICALLYINDUCEDASTIGNATISM
I t ti t f Intraoperative managementof
astigmatismbyOCCI
Dealingwithalltypesofcataractefficientlyandeasily.
MorestabilityoftheAnteriorchamberwithlessPVD.
Dayonecornealclarityasco axialphaco Dayonecornealclarityascoaxialphaco.
Definitelymorerapidrehabilitationthancoaxialphaco.
Lesssurgethancoaxial.
BUT BUT
2003
OZIL technology in Infinti.
So what?
h th O il t h k bi l ith th O il? now we have the Ozil tech, can we work bi-manual with the Ozil?
O il i t i th l ti f Ozil is a corner stone in the revolution of
phacoemulsification
- Torsional.
- More efficient - More efficient.
- Less energy.
- Less shearing force
- Less heat.
To comapre between To comapre between
BIMANUAL PHACOEMULSIFICATION (B-MICS)
And
MICROCOAXIAL PHACOEMULSIFICATION (CO-MICS)
Using the ozil technology in both procedures. g gy p
Learning curve.
D ti f Duration of surgery.
Specular microscopy.
Phaco time and power(EPT)
Corneal Clarity.
Amount of fluids used(FMS).
Surgically induced astigmatism. Surgically induced astigmatism.
Posterior vitreous detachment.
Wound burn Wound burn.
One hundred eyes had been operated for
cataract surgery using the Infinity machine cataract surgery using the Infinity machine
with the Ozil technology with the standard
Kelman tip curved 20 degrees and were divided
into two groups: into two groups:
GROUP 1 :
50 eyes: Bimanual phaco. with the sleeveless 50 eyes: Bimanual phaco. with the sleeveless
kelman tip using Ozil torsion technology from one
site and irrigating chopper from another site of
1.8mm each.
GROUP 2 :
50 eyes: Microcoaxial phaco. was done through
2.2 mm using the Ozil torsion tech. with pink
sleeve
Bimanual phaco with Bimanual phaco. with
The Ozil torsion sleeveless Kelman tip technology from one side and
irrigating chopper from another side of 1.8 mm each.
Microcoaxial phaco through 2 2mm with Ozil torsion technology Microcoaxial phaco through 2.2mm with Ozil torsion technology
using Kelman tip with pink sleeve.
Whataboutfluidics? Whataboutfluidics?
OZILTECHNOLOGYDEPENDSON OZILTECHNOLOGYDEPENDSON
SLEEVESANDTIPS SLEEVESANDTIPS
MICROSMOOTH SLEEVES MICROSMOOTHSLEEVES
Kelman Kelman tips: tips: Kelman Kelman tips: tips:
S d d S d d dd Standard, Standard,20 20degrees, degrees,
12 12degrees degrees 00 9 9tip tip11 11 12 12degrees, degrees,00..9 9tip tip11..11, ,
Mi ifl Mi ifl Miniflare Miniflare. .
MiniFlared Tip Mini FlaredTip
0.9mmMINIFLAREDShaft
0.57mm 0.82mm
9
PERFORMANCEOPTIONS
THERMALPROTECTION
VACUUM
HIGH
HIGH
VACUUM
SURGECONTROL
HIGH
HIGH
0 9mm MiniFlared Tip 0.9mmMini FlaredTip
0.80mm
0.91mm
Reduced Flares
Restriction
Results
-Learning curve.
-Duration of surgery.
-Specular microscopy.
Ph ti d (EPT) -Phaco time and power(EPT)
-Corneal Clarity.
A t f fl id d(FMS) -Amount of fluids used(FMS).
-Surgically induced astigmatism.
Posterior vitreous detachment -Posterior vitreous detachment.
-Wound burn.
Preoperative demographic data
- The mean age in group I
- was 63.6 8.09 y while in group II, it was 65.3 10.5 y. (p = 0.540).
-The mean preoperative BCVA in group I
was 0 11840 122 while in group II it was 0 14840 203 (p=0 530) was 0.11840.122 while in group II, it was 0.14840.203. (p=0.530).
-The mean preoperative keratometric astigmatism in
group I
was 1.284 0.633 D and 1.409 0.868 D in group II (p=0.588).
Different grades of lens density in both
groups:
No statistically significant difference was
found between the two groups as regards found between the two groups as regards
grades of lens density (p=1.00).
preoperative specular microscopy parameters in
th 2 h d the 2 groups, showed
no statistically significant differences.
Technique: q
The "Stop and Chop" technique was used in 92%
of patients in both groups, while the "Chip and Flip"
technique was used in the remaining 8%of patients.
Duration:*
The mean operation time in group I was The mean operation time in group I was
13.481.85 minutes in and in group II, it was
10.83.08 minutes. Astatistically significant difference
was found. (p=0.00)*
The mean EPT *in group I was 9.079.76 seconds and
in group II, it was 7.017.09 seconds.
Statistically significant difference was found (p=0.00)*.
The amount of irrigation fluid* used :
- in group I (B-MICS) had a mean of 228.851.1 ml g p ( )
- in group II (CO-MICS)153.242.79 ml.
A statistically significant difference was found (p=0.00)*.
No intraoperative complications were recorded in
either group. g p
No statistically significant difference was found No statistically significant difference was found
(p=0.140), although 8% of patients in group I
had grade 3 corneal oedema in comparison to
0% in group II .. 0% in group II ..
The mean BCVA in group I was 0 68800 247 and in -The mean BCVA in group I was 0.68800.247 and in
group II, it was 0.65520.287. No statistically significant
difference was found (p=0.667). (p )
The mean refractive astigmatic error recorded in -The mean refractive astigmatic error recorded in
group I was 1.681.19 D and in group II, it was
1.340.87 D. No statistically significant difference was y g
found (p= 0.261).
Bi l h d th Bimanual phaco can reduce the
preexisting astigmatism.
Microcoaxial phaco induces less than a
half diopter of astigmatism.
A statistically significant difference was found A statistically significant difference was found
( P=0.031) as 8% of patients in group I had grade
2 corneal oedema in comparison to 0% in group II
Comparison between specular microscopy parameters
(mean SD) in both groups one week postoperatively ( ) g p p p y
The parameter
Mean SD
P value
I II
-Central corneal thickness (T) 0.5590.041 0.5690.055 0.452
-Minimal cell size (Min) 214.9292.168 225.4262.238 0.644
-Maximal cell size (Max) 1322.52642.8 2253.461968.9
0.030*
-Average cell size (Avg) 548.08200.39 732.88419.25 0.053
-Standard deviation (SD) 284.2135.75 397.5243.5
0.049*
-Coefficient of variation of cell 50.2416 67.1327.59
0.011*
size (CV)
0.011
-Cell density (CD) 1961.5602.72 1747.17618.4 0.225
- The mean BCVA in group I was 0.83200.173 and in The mean BCVA in group I was 0.83200.173 and in
group II, it was 0.8120.217.
No statistically significant difference was found.
(p=0 720) (p=0.720).
- The mean refractive astigmatic error recorded in group I
was 1.511.13 D and in group II, it was 1.190.73 D.
No statistically significant difference was found
(p = 0.243). (p 0.243).
No statistically significant difference was
f d b t th f f th l found between the mean of any of the specular
microscopy parameters in both group one
month postoperatively month postoperatively.
Comparison between the mean difference
(postoperative-preoperative) results in both groups
No statistically significant difference was found
between any mean difference of any variable in y y
both groups.
SO,torevisemytechnologynow,
Bimanualphaco withtheirrigatingchopperfromonesideandthe Bimanualphaco withtheirrigatingchopperfromonesideandthe
phaco handpiece withoutsleevefromotherside.
whathappenstothefluidics?
Beadsstudyonthemicrocoaxial
Notinbimanual
Tosummarize
Whymicrocoaxial Phacoemulsification :
1. FMS.
2. Heatproductionisless(lessincidenceofwoundburn).
3. MICROCOAXIALsurgeislessbytwothirdsthanBiMANUAL.
4. Descement's membrane trauma is less.
5 IOP i h hi h i Bi M l th i i l 5. IOP is much higher in Bi-Manual than micro-coaxial.
6. Higher volume of fluidics is approved in the Bi-Manual.
7. The cornea is more clear day one than bimanual.
8 The incision of 2 2 mm is astigmatically neutral (less than 2 6 mm) 8. The incision of 2.2 mm is astigmatically neutral (less than 2.6 mm).
9. Learning curve is shorer in microcoaxial than bimanual.
Bimanual phacoemulsification has many advantages Bimanual phacoemulsification has many advantages
that extend beyond the smaller incision.
It i f t h i ith h t l i It is a safe technique with a short learning curve once
the optimum machine parameters and surgical
instruments are defined.
With the availability of microincisional IOLs, the
procedure's advantages are even more established procedure s advantages are even more established.
These IOLs proved to be simple, efficient and having
excellent optical properties.
Combing cool or low ultrasound systems with the
procedure definitely abolishes the fear of corneal
wound burn.
No statistically significant differences were found
between the two techniques regarding the
t ti BCVA f ti ti ti postoperative BCVA, refractive astigmatism,
surgically induced astigmatism or specular
microscopy parameters at the end of the follow up
period.
No intraoperative complications were reported in No intraoperative complications were reported in
either group.
The bimanual phaco group had a statistically The bimanual phaco group had a statistically
significant more total operation time and total
amount of irrigation fluid used.
1.8 mm incision, 2.2 mm incision are astigmatic ally
neutral incisions neutral incisions.
IOL insertion could be done through another incision g
and astigmatism could be corrected through another
incision
Graphic : Hassan El Graphic : Hassan El- -Sheikh Sheikh - - 03 420 55 24 03 420 55 24 . Alex. Egypt . Alex. Egypt