EyeWorld is the official news magazine of the American Society of Cataract & Refractive Surgery.
Issue link: https://digital.eyeworld.org/i/1160558
36 | EYEWORLD | SEPTEMBER 2019 ATARACT C Contact information Garg: gargs@uci.edu MacDonald: susanmacdonaldeyecorps@gmail. com Wiley: wiley@cle2020.com by Rich Daly EyeWorld Contributing Writer DEVICE FOCUS have been neglected in Tanzania." She said the device helped her in such cases. Area for caution The type of cases where Dr. MacDonald has found cause for caution are those with zonular dehiscence that is significant or progressive, such as pseudoexfoliation patients who already have some zonular dialysis. "In a patient that has had some traumatic dialysis, I am still able to use it," Dr. MacDon- ald said. The precaution on miLOOP's use in cases of zonular weakness was common among sur- geons treating such patients. "It can be used on most any cataracts ex- cept cases with overt zonular weakness, where there is phacodonesis," Dr. Wiley said. "That said, it can be used successfully in pseudoexfo- liation cases that have not developed truly loose zonules." S urgeons have found a device that helps them surgically treat most cataract patients. William Wiley, MD, has used the miLOOP (Carl Zeiss Meditec), an instrument with a super elastic, nitinol microfilament that wraps around a cataract for centripetal endocapsular nuclear disassembly, for about 2 years and in 500 eyes. The lenses ranged from clear to hypermature cataracts; he's also used it in complex cases in- cluding small pupil and post-vitrectomy eyes. Sumit "Sam" Garg, MD, has used miLOOP for about 1 year and generally reserves it for dense or brunescent cataracts. In dense lenses, "it assures a complete frag- mentation of the lens, which can be complicat- ed by posterior bridging fibers," Dr. Garg said. "Also, because the lens is fragmented, I am able to use less phaco energy." Dr. Wiley agreed the device can divide the lens in multiple pieces in an atraumatic fashion allowing for more efficient cataract extraction with less phaco energy. He also cited easier lens fragment removal with less chance of capsule rupture or vitreous loss. Susan MacDonald, MD, said another advan- tage the device has provided is in her instruc- tion of surgeons who do not feel comfortable with phacoemulsification. "It allows doing divide and conquer phaco without having to go through a lot of time learning divide and conquer and chopping," Dr. MacDonald said. "It can be very simply a one-handed technique without using the phaco machine to do the divide and conquer." Dr. MacDonald said the device stemmed from an effort to find a technology that would be applicable in low-resource settings, such as where surgeons cannot afford a phacoemulsi- fication machine. Such settings are where most of her miLOOP experience has come from, although she also has used it with phaco. "I have used miLOOP on some of the most difficult cataracts on which I have ever operated," Dr. MacDonald said. "These are mature, 5+, 6+ nuclear sclerotic cataracts that Broad usefulness of miLOOP, surgeons say About the doctors Sumit "Sam" Garg, MD Medical director Gavin Herbert Eye Institute University of California, Irvine Susan MacDonald, MD Associate professor Tufts University School of Medicine Boston William Wiley, MD Assistant clinical professor University Hospitals/ Case Western Reserve Cleveland Relevant financial interests Garg: Carl Zeiss Meditec, Johnson & Johnson Vision MacDonald: Carl Zeiss Meditec, Perfect Lens Wiley: Carl Zeiss Meditec continued on page 38 miLOOP placement under anterior capsule Bisecting nucleus in half Source: Summit "Sam" Garg, MD