ADVANCES IN CATARACT SURGERY. BIMANUAL MICROINCISIONAL TECNIQUES

New technique in cataract surgery without sutures no injection and no covering the eye, with a nearly immediate visual recovery. Bimanual microincisional techniques are more effective and safer, obtaining greater comfort for the patient and visual and functional recovery quicker than with conventional techniques. This is one of the conclusions reached in the 43 Congress of the Catalan Society of Ophthalmology.

During November 30th and December first was held in Barcelona the 43 Congress of the Catalan Society of Ophthalmology and one of the key subjects was the cataract surgery with bimanual microincisional techniques (Bimanual- MICS). This is to reduce surgical trauma, the risk of complications and improve efficiency to achieve a faster patient recovery.

The novelty of these techniques was how to achieve these objectives and this Congress have laid some of the groundwork for their achievement. In summary we can say that it has been discussed on the technology used and the surgical approach

With regard to technology, we have the new phacoemulsification systems, some based on cold micropulse ultrasound and others based on the femtosecond laser. Both have advantages and disadvantages, and although it is not our purpose to enter into this debate, what is important is to know that both systems are equally valid to get good results, but we believe that laser systems provide significant advantages in the next future.

Figure 1.-  Femtosecond laser assisted Bimanual-MICS (Dr Vergés).

Figure 1.- Femtosecond laser assisted Bimanual-MICS (Dr Vergés).

Regarding the surgical approach is where most changes have undergone. Bimanual microincisional techniques (Bimanual-MICS) have shown more advantages over other techniques in both, efficiency and safety. Scientific evidence found in the literature, in comparative studies, shown as fewer complications and a faster recovery of patients, both in terms of vision as to the return to normal life, as shown in the article published by doctors, Alió, Vergés and Klonowsk (click).

Figure 2. – Bimanual-MICS. Outline fluidc within the anterior chamber (left), and detail of the horizontal nucleus fracture maneuver with the Verges irrigating-chopper and the Vergés phaco-needle, (right).

Figure 2. – Bimanual-MICS. Outline fluidc within the anterior chamber (left), and detail of the horizontal nucleus fracture maneuver with the Verges irrigating-chopper and the Vergés phaco-needle, (right).

Bimanual-MICS surgery is performed with sedation and local anesthesia, and in most cases it is not necessary to “puncture” the eye or orbit with regional anesthesia injections, no sutures were required to close the incisions, as they are very small and have a very safe self-sealing. This makes the patient feel very comfortable during surgery and quit watching and can go home (outdoor surgery), and while it still requires some rest that day and can perform certain activities, such as watching TV or even read .

When performing surgery in both eyes in the same surgery, on the same day, which is called bilateral surgery (click), is where the Bimanual MICS offers more advantages, getting an even faster recovery because both eyes send similar information to the brain and adaptation is easier and faster, especially if we have implanted multifocal intraocular lenses, to see far and near.

We are pioneer in this technique and have been doing this surgery for over 10 years in our center, Area Oftalmológica Avanzada, with very satisfactory results, so now we are very proud when the ophthalmological community recognize the advantages and consider this technique the most advanced surgery for cataracts.

To carry out Bimanual-MICS we need technology and new instruments and, especially, a team well combined. It is essential that the anesthetist can make a good sedation, so the patient is quiet and does not move, as if it were a general anesthetic but without the risks of this and that the patient can recover straight after surgery, in order to return home without resting in the surgical center.

On another level, the surgeons and assistants will form a team to perform surgery correctly, since these techniques require greater precision and a more precise control on the technology used (ultrasound or laser).

If we combine these factors, technology and human resources, the result will be very successful, with a high level of efficiency and security that allow faster recovery, only a few days to return normal life. We are encouraging both ophthalmologists who have not perform these techniques to change as soon as possible, as well as patients who will have cataract surgery, to consult the benefits of the Bimanual-MICS.

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