Comparison Of Intra-Operative Phaco Energy And Post-Op Endothelial Cell Density With And Without The Use Of Miloop For Hard Cataracts.

To compare the cumulative dissipated energy (CDE), Equivalent average US time, and post-op endothelial cell density (ECD) with and without the use of mi-Loop for hard cataracts in eyes undergoing phacoemulsification (PHACO).

NETHRADHAMA SUPERSPECIALITY EYE HOSPITAL, BANGALORE, INDIA.

This prospective study included 40 eyes of 20 patients with nuclear sclerosis grade 4 and above, undergoing cataract surgery with PHACO using the Centurion system (Alcon surgical). Eyes were randomised into two groups -group 1 phaco only and group 2 PHACO with miLoop, wherein the miLoop instrument was used to assist in fragmentation of the hard brown nucleus. All surgeries were performed by a single experienced surgeon using the same energy and fluidics parameters. Intra-operatively, the mean CDE value and Equivalent average US power was noted. Post-operatively at day 1 and 6 months, the mean ECD was compared between both the groups.

Pre-operatively, both groups were matched in terms of mean age, grade of cataract and ECD( p>0.05 for all parameters). Intra-operatively, the phaco only group had a mean CDE value of  19.42 ±5.32, whereas the PHACO+ miLoop group had a CDE value of  15.91±5.54( p=0.02). The PHACO only group had a mean Equivalent average US power of 22.86±3.12, whereas PHACO+ mi-Loop group had an Equivalent average US power of 20.82±3.41(p=0.02). At 6 months, the mean ECD in phaco only group was 2125±124 cells versus 2356±143 suggesting a significantly higher ECD loss in phaco only group (p=0.02). No eye in either group had intra-op complications such as PCR, ZD or bag loss, or post op issues such as irreversible corneal oedema or endothelial decompensation.

miLoop may be a useful tool to assist in the management of hard brown cataracts and may lead to less ultrasound usage and ECD loss compared to routine phacoemulsification in such cases.