Eyeworld

EW CATARACT 34 July 2018 by Liz Hillman EyeWorld Senior Staff Writer Research highlight (MSICS) with a 5.0 mm incision made possible due to nuclear disas- sembly with miLOOP. As executive director of Eye Corps, a nonprofit organization, Dr. MacDonald said she is teaching and using the instrument while working in Tanzania, where almost all of the cataracts she's seeing are grades 3 and above. "I'm using miLOOP exclu- sively when I'm operating," she said, noting later that a completely phaco-free procedure can be done with MSICS and miLOOP, bringing the fragments through a smaller incision than with typical MSICS. She also said she finds it useful in small pupil cases. "I have found it helpful be- cause those cases tend to be the ones where if you don't get a good chop in the beginning, you end up bowling them out, and it becomes a stressful situation where you're trying to grab that epinuclear bowl under the pupil and bring it in," Dr. MacDonald said. "If you can divide the lens into four quadrants and remove those four quadrants with phaco, that small pupil case becomes a simple case." Overall, Dr. MacDonald said she thinks learning to use miLOOP is intuitive, which for her, at the start, was the sticking point. "What's different for me is that with most tools I've used in surgery, I've had to learn how to efficiently manipulate them. I've realized with this tool, I don't have to develop a technique, but just follow the directions. All I have to do is place the miLOOP in under the anterior capsule and push the button to fully expand it. Once it is fully expanded, I gently sweep the miLOOP between the capsule and the nucleus by rotating my wrist and keeping the instrument centered in the eye. Trusting the instrument was part of my learning curve—understanding that it would follow the directions and it would just work." William Wiley, MD, assistant clinical professor of ophthalmology, University Hospitals/Case Western University, Cleveland, who was not involved in the British Journal of Ophthalmology study but did York, and co-founder of the mi- LOOP technology and Iantech. "Unlike femto and lasers that do prepare the lens … [miLOOP] is a simple, hand-held instrument that uses no energy to prepare the lens to segment it and make phaco easier." Though time of the surgical cas- es was not recorded as an outcome measure, Dr. Ianchulev said the use of miLOOP did not lengthen the procedure. Dr. MacDonald, who said she uses miLOOP for complicated cases outside of this study, said it makes the procedure more efficient, safer, and ultimately faster. In addition to this paper, Dr. Ianchulev noted that Iantech intro- duced biLOOP, a two-filament mul- tiloop for nuclear fragmentation, at the 2018 ASCRS•ASOA Annual Meeting. There were almost a dozen peer-reviewed paper presentations at the ASCRS•ASOA Annual Meet- ing on miLOOP; two were awarded Best Paper of Session awards. These included one that looked at nuclear disassembly with miLOOP in 4–4+ cataracts and another that discussed outcomes of "minicap," manu- al small incision cataract surgery Dr. MacDonald was one of the investigators on the first-in-human randomized, prospective clinical trial to compare phacoemulsifica- tion alone vs. phaco and prefrag- mentation of dense cataracts with miLOOP, published in the British Journal of Ophthalmology. 1 One hundred and one eyes with grade 3–4+ nuclear cataracts were randomized to either undergo torsional phacoemulsification or prefragmentation with miLOOP followed by torsional phacoemul- sification. The mean cumulative dispersed energy was 53% higher in the phaco alone group, while endothelial cell loss was similar between the two groups, Ianchulev et al. wrote. "We're showing that in the hands of great surgeons, very ex- perienced choppers, and with the top-of-the-line, latest equipment with torsional ultrasound, you can dramatically reduce heat and energy delivered to the eye by using the miLOOP," said Sean Ianchulev, MD, professor of ophthalmology, New York Eye and Ear Infirmary, Icahn School of Medicine, New Microinterventional nucleus disassembly with miLOOP resulted in significantly less phaco energy in moderate to advanced cataract I t has been a year since miLOOP (Iantech, Reno, Nevada), an instrument with a superelas- tic, nitinol microfilament that wraps around a cataract for centripetal endocapsular nuclear disassembly, was introduced. Susan MacDonald, MD, as- sociate professor, Tufts University School of Medicine, Boston, said she uses it as her "go-to instrument" for difficult cases, including small pupils, zonular instability, hard cat- aracts, and even soft premium lens cataracts. "It has improved my surgical time and my technique. This device makes a cases easier, and I use less phaco energy, which ultimately results in a better outcome for the patient," Dr. MacDonald said. First-in-human randomized controlled study compares phaco with miLOOP and phaco alone Researchers evaluated the efficacy of miLOOP in dense, mature cataract cases compared to traditional phacoemulsification. Source: Sean Ianchulev, MD

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