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. 2016 May 26:10:979-87.
doi: 10.2147/OPTH.S103540. eCollection 2016.

Long-term follow-up for bimanual microincision cataract surgery: comparison of results obtained by surgeons in training and experienced surgeons

Gian Maria Cavallini  1 , Tommaso Verdina  1 , Matteo Forlini  1 , Veronica Volante  1 , Michele De Maria  1 , Giulio Torlai  1 , Caterina Benatti  1 , Giancarlo Delvecchio  1
Affiliations

Long-term follow-up for bimanual microincision cataract surgery: comparison of results obtained by surgeons in training and experienced surgeons

Gian Maria Cavallini et al. Clin Ophthalmol. .

Abstract

Purpose: To determine the efficacy of bimanual microincision cataract surgery (B-MICS) performed by surgeons in training, evaluating clinical results, posterior capsule opacification (PCO) incidence, and clear corneal incision (CCI) architecture in a long-term follow-up and comparing results with those obtained by experienced surgeons.

Patients and methods: Eighty eyes of 62 patients operated on by three surgeons in training who used B-MICS technique for the first time were included in the study (Group A). Eighty eyes of 59 patients who underwent B-MICS by three experienced surgeons were included as a control group (Group B). Best corrected visual acuity, astigmatism, corneal pachymetry, and endothelial cell count were evaluated before surgery and at 1 month and 18 months after surgery. Anterior segment optical coherence tomography images were obtained to study the morphology of CCIs. PCO incidence was evaluated using EPCO2000 software.

Results: Out of 160 surgeries included in the study, mean best-corrected visual acuity improvement at 18 months was 0.343±0.246 logMAR for Group A, and 0.388±0.175 logMAR for Group B, respectively. We found no statistically significant induced astigmatism nor corneal pachymetry changes in either group, while we noticed a statistically significant endothelial cell loss postoperatively in both groups (P<0.05). In Group A, mean PCO score was 0.163±0.196, while for Group B, it was 0.057±0.132 (P=0.0025). Mean length and inclination of the CCIs for Group A and Group B were, respectively, 1,358±175 µm and 1,437±256 µm and 141.8°±6.4° and 148.7°±5.1°. As regards corneal architecture in the 320 CCIs considered, we found posterior wound retractions and endothelial gaps, respectively, 9.8% and 11.6% for Group A and 7.8% and 10.8% for Group B.

Conclusion: B-MICS performed by surgeons in training is an effective surgical technique even when assessed after a long-term follow-up. PCO incidence resulted in being higher for less experienced surgeons. Corneal incisions were shorter and less angled in surgeons in training in comparison with results obtained by expert surgeons.

Keywords: B-MICS; clear corneal incisions; learning curve; posterior capsule opacification; small incisions.

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Figures

Figure 1
Figure 1
PCO analysis with EPCO2000 software in two study cases. Note: Right panels are pictures from the slit lamp, left panels are the pictures from the correspondent software analysis. Abbreviation: PCO, posterior capsule opacification.
Figure 2
Figure 2
Microincision length and angle as measured with AS-OCT. Notes: (A) B-MICS trapezoidal microincision made with a diamond knife. (B) Microincision length. (C) Microincision angle tangential to cornea. Abbreviation: AS-OCT, Anterior segment optical coherence tomography.
Figure 3
Figure 3
Anterior segment OCT scans showing morphological alterations. Notes: (A) Epithelial gap. (B) Endothelial gap. (C) Descemet’s stripping. (D) Posterior wound retraction (PWR) at the microincision site (inner side). Abbreviation: OCT, optical coherence tomography.
Figure 4
Figure 4
Posterior capsule scraping performed by an expert surgeon. Note: (A) Scraping with a smooth 26 G cannula, and (B) with bimanual I/A probes. Abbreviation: I/A, irrigation/aspiration.
See this image and copyright information in PMC

References

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