Surgical experience in dense cataracts with and without the miLOOP lens fragmentation device: a retrospective consecutive-case series
First Author: E.Hu USA
Dense mature cataracts are associated with higher rates of capsule complications. They also require increased phaco ultrasound energy during lens fragmentation and extraction. The miLOOP lens fragmentation device employs a nitinol microfilament loop to safely mechanically divide the lens while minimizing strain on the capsule and zonules by directing all the mechanical forces centrally inwards. The purpose of this study was to evaluate the impact of introducing the miLOOP device in cases with advanced cataracts on intraoperative outcomes.
Single surgeon operating in multiple ambulatory surgical center and hospital-based ORs in a private practice setting
This study is a consecutive-case retrospective chart review over a 3-year period (2 years prior to introduction of the miLOOP device, and 1 year following). Eyes with dense cataracts (LOCS III N06 NC6 and higher) were included in the analysis. The rates of intraoperative complications and phaco time (cumulative dispersed energy) were recorded and compared pre- and post-miLOOP introduction.
A total of 928 cases to date were eligible for analysis, with n=641 prior to miLOOP (Group 1) and 287 with miLOOP (Group 2). Utilization of the miLOOP device resulted in a 38% reduction trend in capsule complications (4.5% vs. 2.8%). Notably, there was a trend toward a further reduction in complication rates in Group 2, with the last quartile of cases having a 0% complication rate. There was also a 15% reduction in cumulative dispersed energy after introduction of the miLOOP device, with 12.3 ± 6.9 vs. 10.5 ± 5.6 for Groups 1 and 2, respectively (p<0.001).
The miLOOP shows potential in significantly reducing the rates of intraoperative capsule complications, which in turn may lead to better long-term visual outcomes and greater case volume efficiency per OR session. Less phaco ultrasound energy is required to fragment dense nuclei with the miLOOP device. Higher levels of phaco use have been correlated to increased post-operative corneal edema and risk of corneal endothelial cell loss over time, and so reducing this energy may be beneficial for faster visual recovery and increased long-term corneal health.
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