Comparison of two differents ultrasound mode in BMICS

Comparison of two differents ultrasound mode in BMICS technique : Pulse and Continuous US Danielle DEIDIER M. D. Clinique Saint Vincent Toulon - France The author of this poster have received travel expense reimbursement from Bausch+Lomb ASCRS 2011 San Diego

PURPOSE To compare the ultrasound mode Pulse and the ultrasound mode Continuous in term of safety and efficiency during a bimanual micro incision cataract surgery

METHODS ► Prospective study ► Same surgeon ► Stellaris™ system (Bausch + Lomb) ► Bimanual MICS (2 incisions of 1. 3 mm) ► Handpiece 28, 5 Khz ► 90 patients (90 eyes) ► Two groups : ►Group 1 : 45 patients, US mode Pulse ►Group 2 : 45 patients, US mode Continuous.

CRITERIA ANALYSED ► Cornea edema post op D 1 ► Complication during surgery (capsular rupture) ► Endothelial cells loss ► UCVA and BCVA ► EPT (effective phaco time) ► APT (average phaco time) ► Phacoemulsification time ► Sealing of incision site at D 1 – D 8 ► Nucleus density : grade 2, 3 or 4 ► Balanced salt solution volume used during surgery

RESULTS NUCLEUS HARDNESS Group 1 (US pulses) : § Mean: 2, 6 ± 0, 3 ► Group 2 (US continuous) : § Mean: 2, 7 ± 0, 4 ► P=0, 15 ns Groups were comparable

RESULTS 25 160 140 US PULSE CONTINOUS 20 US PULSE CONTINOUS 120 100 15 80 10 60 40 72, 5 9, 2 5 46 4, 6 20 0 0 APT (sec) p=0, 0001 22, 5 20 EPT (sec) p= 0, 0006 US PULSE CONTINOUS 17, 5 15 12, 5 10 7, 5 11, 9 9, 1 5 2, 5 0 ► US % p=0, 003 As expected, US delivery was higher with the US continuous mode

RESULTS COMPLICATION DURING SURGERY BSS VOLUME ► Group 1 (US pulses) : Nothing to report ► Group 2 (US continuous) : Nothing to report CORNEA EDEMA Post op D 1 ► Group 1 (US pulses): § 2 edemas moderate ► Group 2 (US continuous): § 1 edema moderate Group 1 ( US pulses): § BSS(ml): 39 ± 10, 3 P=0, 25 ns Group 2 ( US continuous): § BSS(ml): 37 ± 6, 3 INCISION LEAKAGE D 1 & D 8 ► In both group, no leak at the incision at D 1 and D 8.

RESULTS Endothelial cell loss p=0, 36 ns There was no statiscally significant difference between both groups

RESULTS 20/80 20/63 20/50 20/80 20/40 20/63 20/32 20/50 20/25 20/40 20/20 20/32 P=0, 002 Distinction between both group, UDVA & CDVA is not clinically significant. 20/25 20/20 P=0, 0001

IN SUMMARY ► As expected the US delivery is more important in group 2 (US continuous) ► In both group: § No complication during surgery § 2 moderate edemas in group 1, 1 moderate edemas in group 2 § Incisions are tight at D 1 & D 8 § No statiscally significant difference between both group for endothelial cell loss § Distinction between both group in term of UDVA & CDVA are not clinically significant § BSS volume used is equivalent

CONCLUSION ► Despite a higher US delivery in continuous mode (Mean US 72, 5%) compare to pulse mode (Mean US 46%), we observed that a low frequency handpiece (28, 5 Khz) with Stellaris™system allow an efficent and secure surgery in BMICS. ► Consequently the continuous US mode is safe and can be used in several cases as challenging cases or hard nucleus.