Is microincisional surgery really the best option?

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The trend for microincisional procedures is escalating. Dr Boris Malyugin compares SICS and C-MICS.

Key Points

Because a MICS incision is smaller than the incision created by the conventional coaxial technique, one might expect improved outcomes, resulting in improved visual acuity. Previously published studies have established that the MICS technique is truly astigmatically neutral, making it ideal for refractive lens exchange; the technique is also associated with a decreased likelihood of postoperative wound leakage when compared with a larger incision procedure, thereby also reducing the risk of endophthalmitis.


That is why, nowadays, most surgeons prefer the coaxial surgical technique. My personal preference is a C-MICS procedure performed completely through an unenlarged 1.8 mm incision with the Stellaris system (Bausch & Lomb).

To evacuate the lens material through the smaller bore needle used in this technique, it is necessary to fragment the lens into particles of smaller diameter than is required by the standard diameter ultrasound (US) needle. Theoretically, with the larger diameter phaco needle, one could expect that, to emulsify the lens nucleus, a lower amount of US energy would be necessary.

Comparing C-MICS with SICS

Although there have previously been a number of studies assessing the outcomes of MICS, no studies have, to the best of my knowledge, compared the postoperative outcomes of 1.8 mm C-MICS with the outcomes of 2.8 mm SICS (small incision cataract surgery) when performed with the latest generation of phaco machines.

I conducted a study to assess if the differences in both the incision size and the US needle diameter - when using the same system and the same settings - influence either the utilization of the US energy and irrigating fluid or the clinical outcomes of cataract surgery.

Both groups underwent phacoemulsification using the same surgical settings: