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The aim of the study is to compare functional results and complications of 3 methods of cataract phacoemulsification: bimanual 1.4 mm cataract surgery (B-MICS), coaxial 1.8 mm cataract surgery (C-MICS) and coaxial 2.4 mm small incision cataract surgery.
Reduction of the width of the corneal incision was one the main changes taking place in cataract surgery in recent years. The common use of foldable intraocular lenses (IOLs) and technological development of phaco machines allowed to reduce clear corneal incision below 3 mm. Term of Microincision Cataract Surgery (MICS) understood as cataract phacoemulsification performed with the incision width below 2 mm was defined by professor Alio in 2003. However, despite various modifications introduced in recent years, phacoemulsification still causes damage of the tissues that results in surgically induced astigmatism.
Two MICS techniques have been developed: bimanual microincision cataract surgery (B-MICS) and coaxial microincision cataract surgery (C-MICS).
In the bimanual technique cataract phacoemulsification can be performed through the main incision 1.4 mm wide due to the usage of sleeveless phaco tip (without irrigation) and irrigation chopper. The advantage of separation the irrigation from aspiration is improvement of liquid dynamics in the anterior chamber. Moreover, due to the usage of the irrigation chopper, in B-MICS it is possible to lower the mean ultrasound energy.
In coaxial technique MICS phacoemulsification is performed through the incision 1.8 mm wide with usage of phaco tip with a silicon irrigation sleeve.
The aim of the study is to compare functional results and complications of 3 methods of cataract phacoemulsification: bimanual 1.4 mm cataract surgery (B-MICS), coaxial 1.8 mm cataract surgery (C-MICS) and coaxial 2.4 mm small incision cataract surgery. Moreover, this study aimed to evaluate the impact of corneal width on best corrected visual acuity (uncorrected and corrected), surgically induced astigmatism, endothelial cell loss, intraocular pressure, anterior segment of the eye and central retinal thickness.
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| Label | Type | Description | Intervention Names |
|---|---|---|---|
| B-MICS 1.4 mm | Experimental | bimanual 1.4 mm cataract surgery (B-MICS) |
|
| C-MICS 1.8 mm | Active Comparator | coaxial 1.8 mm cataract surgery (C-MICS) |
|
| C-SICS 2.4 mm | Active Comparator | coaxial 2.4 mm small incision cataract surgery (C-SICS) |
|
| Name | Type | Description | Arm Group Labels | Other Names |
|---|---|---|---|---|
| Bimanual 1.4 mm microincision cataract surgery (B-MICS) with IOL implantation in a "wound-assisted" technique. In bimanual MICS group a self-sealing 1.4 mm wide incision was created supratemporally | Procedure | microincision cataract surgery (phacoemulsification) with implantation of a foldable, acrylic, hydrophilic IOL Incise® MJ14, Bausch & Lomb |
| Measure | Description | Time Frame |
|---|---|---|
| the best corrected visual acuity | examined with digital Snellen chart, measured in decimal scale | 36 months |
| the best uncorrected visual acuity | examined with digital Snellen chart, measured in decimal scale | 36 months |
| autorefractometry | measured in diopters (D) | 36 months |
| keratometry | measured in diopters (D) | 36 months |
| intraocular pressure (IOP) | measured in millimeters of mercury (mmHg) | 36 months |
| endothelial cell density (ECD) | measured in endothelial cells/mm2 | 36 months |
| central corneal thickness (CCT) | measured with Anterior Segment Optical Coherence Tomography (AS-OCT), unit of measure: µm (micrometers). | 36 months |
| peripheral temporal corneal thickness | measured at the main incision site with Anterior Segment Optical Coherence Tomography (AS-OCT), unit of measure: µm (micrometers) | 36 months |
| Measure | Description | Time Frame |
|---|---|---|
| surgically induced astigmatism SIA | measured in dioptres (D) - three different methods were used for calculation of surgically induced astigmatism (SIA): vector analysis method, vector decomposition method (C90), Naeser's polar values method (dKP-90) | 36 months |
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Inclusion Criteria:
Exclusion Criteria:
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|
| Coaxial 1.8 mm microincision cataract surgery (C-MICS) with IOL implantation with an injector through the 1.8 mm wide incision created temporally. | Procedure | microincision cataract surgery (phacoemulsification) with implantation of a foldable, acrylic, hydrophilic IOL Incise® MJ14, Bausch & Lomb |
|
| Coaxial 2.4 mm small incision cataract surgery (C-SICS) with IOL implantation with an injector through the 2.4 mm wide incision located temporally. | Procedure | small incision cataract surgery (phacoemulsification) with implantation of a foldable, acrylic, hydrophilic IOL Incise® MJ14, Bausch & Lomb |
|
| peripheral nasal corneal thickness |
measured with Anterior Segment Optical Coherence Tomography (AS-OCT), unit of measure: µm (micrometers) |
| 36 months |
| anterior chamber depth (ACD) | measured with Anterior Segment Optical Coherence Tomography (AS-OCT) in mm (milimeters). | 36 months |
| the white-to-white (WTW) distance - the horizontal corneal diameter | measured with Anterior Segment Optical Coherence Tomography (AS-OCT, unit of measure: mm (milimeters). | 36 months |
| length of the clear corneal incision | the chord length measured with Anterior Segment Optical Coherence Tomography (AS-OCT), unit of measure: µm (micrometers) | 36 months |
| anterior chamber angle | measured with Anterior Segment Optical Coherence Tomography (AS-OCT) in horizontal scan, unit of measure: degrees | 36 months |
| central foveal thickness (CFT) | measured with Optical Coherence Tomography (OCT), unit of measure: µm (micrometers) | 36 months |
| parafoveal retinal thickness | measured with Optical Coherence Tomography (OCT), unit of measure: µm (micrometers) | 36 months |
| ID | Term |
|---|---|
| D002386 | Cataract |
| D001251 | Astigmatism |
| ID | Term |
|---|---|
| D007905 | Lens Diseases |
| D005128 | Eye Diseases |
| D012030 | Refractive Errors |
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