Sean Ianchulev MD, MPH
A micro-interventional device that can be inserted through a 1.5mm incision to fragment any grade of cataract was unveiled at ASCRS and is now commercially available in the US. The manual device makes possible extraction of grade 1 and 2 cataracts with no ultrasound energy, and harder nuclei with greatly reduced energy, Sean Ianchulev MD, MPH, told the 2017 American Society of Cataract and Refractive Surgery Symposium in Los Angeles, USA.
The MiLoop device consists of a retractable loop of micro-thin Nitinol filament, which is a super-elastic memory-shaped material used to make stents and other microsurgical devices, attached to a handle. The loop is inserted into the capsule after hydrodissection, opened radially and pulled down around the nucleus in the hydrodissection plane. When the loop reaches completely around the nucleus, it is cinched into the handle, cutting through the nucleus from the outside in.
The procedure can be repeated to chop even the hardest nuclei into four, six or more segments that can then be easily aspirated, said Dr Ianchulev, who is professor of ophthalmology at the New York Eye and Ear Infirmary, Icahn School of Medicine, Mount Sinai, New York City, USA.
The loop is the first of a suite of micro-interventional devices in development by Iantech, Inc (
iantechmed.com). Unlike conventional nucleus disassembly, the MiLoop does centripetal lens fragmentation without the need of phaco or second instrument. It also puts less stress on the capsule and zonules even when fragmenting a hard nucleus because it exerts pressure from the outside in. “Where we now do in-out fragmentation by cracking, with this we do out-in, in what I call centripetal fragmentation,” Dr Ianchulev said.
LEARNING FROM MIGS
The MiLoop, in development by Dr Ianchulev’s company Iantech, is part of an effort to overcome some of the shortcomings of phacoemulsification, Dr Ianchulev said. These include unnecessary energy dispersion in all types of cataracts and avoiding excessive trauma removing harder cataracts.
Beyond requiring no ultrasound energy and reducing pressure on the capsule, it reduces the need for irrigation and aspiration and multiple chopping instruments.
Additional instruments to reduce trauma and dispersed energy in cataract surgery are in the works, Dr Ianchulev said. The goal is a clear cornea on day one, and a refractive outcome comparable to LASIK. “Ultimately we can achieve true north and be the best that we can be for our patients.”
Dr Ianchulev was inspired to design the MiLoop by his work developing glaucoma devices and observing loops used in other surgical procedures. He has a long track record as an innovator as head of development for Lucentis, the inventor of intraoperative aberrometry and the developer of the first supraciliary MIGS device – the CyPass Micro-Stent.
The ASCRS presentation on this technology is available below.
Sean Ianchulev: tianchul@yahoo.com
