I i iI i i i d tii d tiIncisionIncision size reductionsize reduction

Transition from coaxial phaco to Bi manual phaco is :Transition from coaxial phaco to Bi-manual phaco is :True transition, Lot of advantages:

Less wound size allover the surgeryg y

Working through 1 8mm incision Working through 1.8mm incision all of the time.

IOL insertion  from any site needed withNO SURGICALLY  INDUCED ASTIGNATISM

I t ti t  f Intraoperative management of astigmatism by OCCI 

• Dealing with all types of cataract efficiently and easily. 

• More stability of the Anterior chamber with less PVD.

• Day one corneal clarity as co axial phaco• Day one corneal clarity as co‐axial phaco.

• Definitely more rapid rehabilitation than coaxial phaco.

Less surge than co‐axial.

BUTBUT 2003OZIL technology in Infinti.

So what?h th O il t h k bi l ith th O il?now we have the Ozil tech, can we work bi-manual with the Ozil?

O il i t i th l ti fOzil is a corner stone in the revolution of phacoemulsification

- Torsional.

- More efficient- More efficient.

- Less energy.

- Less shearing force

- Less heat.

To comapre betweenTo comapre between BIMANUAL PHACOEMULSIFICATION (B-MICS)And MICROCOAXIAL PHACOEMULSIFICATION (CO-MICS)Using the ozil technology in both procedures.g gy p

Learning curve.D ti fDuration of surgery.Specular microscopy.Phaco time and power(EPT)Corneal Clarity. Amount of fluids used(FMS).Surgically induced astigmatism.Surgically induced astigmatism.Posterior vitreous detachment.Wound burnWound burn.

One hundred eyes had been operated for

cataract surgery using the Infinity machinecataract surgery using the Infinity machine

with the Ozil technology with the standard

Kelman tip curved 20 degrees and were divided

into two groups:into two groups:

GROUP 1 :

50 eyes: Bimanual phaco. with the sleeveless50 eyes: Bimanual phaco. with the sleevelesskelman tip using Ozil torsion technology from onesite and irrigating chopper from another site of1.8mm each.

GROUP 2 :

50 eyes: Microcoaxial phaco. was done through2.2 mm using the Ozil torsion tech. with pinksleeve

Bimanual phaco withBimanual phaco. withThe Ozil torsion sleeveless Kelman tip technology from one side and

irrigating chopper from another side of 1.8 mm each.

Microcoaxial phaco through 2 2mm with Ozil torsion technologyMicrocoaxial phaco through 2.2mm with Ozil torsion technology using Kelman tip with pink sleeve.

What about fluidics?What about fluidics?

OZIL TECHNOLOGY DEPENDS ON OZIL TECHNOLOGY DEPENDS ON SLEEVES AND TIPSSLEEVES AND TIPS

MICROSMOOTH SLEEVESMICROSMOOTH SLEEVES

KelmanKelman tips:tips:KelmanKelman tips:tips:

S d d  S d d     dd‐‐ Standard, Standard, 20 20 degrees,degrees,

12 12 degrees   degrees   00 9 9 tip tip 11 11   12 12 degrees,  degrees,  00..9 9 tip tip 11..11, , 

Mi iflMi ifl     ‐‐MiniflareMiniflare.  .  

Mini‐Flared TipMini Flared Tip

0.9 mm MINI‐FLARED Shaft

0.57mm 0.82mm

9

PERFORMANCE OPTIONSTHERMAL PROTECTIONVACUUM

HIGHHIGHVACUUM

SURGE CONTROLHIGHHIGH

0 9mmMini‐Flared Tip0.9mm Mini Flared Tip

0.80mm0.91mm

Reduced Flares Restriction

Results-Learning curve.-Duration of surgery.-Specular microscopy.Ph ti d (EPT)-Phaco time and power(EPT)

-Corneal Clarity. A t f fl id d(FMS)-Amount of fluids used(FMS).

-Surgically induced astigmatism.Posterior vitreous detachment-Posterior vitreous detachment.

-Wound burn.

Preoperative demographic data - The mean age in group I

- was 63.6 ±8.09 y while in group II, it was 65.3 ±10.5 y. (p = 0.540).

-The mean preoperative BCVA in group Iwas 0 1184±0 122 while in group II it was 0 1484±0 203 (p=0 530)was 0.1184±0.122 while in group II, it was 0.1484±0.203. (p=0.530).

-The mean preoperative keratometric astigmatism in group I

was 1.284 ± 0.633 D and 1.409 ± 0.868 D in group II (p=0.588).

Different grades of lens density in both groups:

No statistically significant difference was found between the two groups as regardsfound between the two groups as regards

grades of lens density (p=1.00).

preoperative specular microscopy parameters in th 2 h dthe 2 groups, showed

no statistically significant differences.

Technique:qThe "Stop and Chop" technique was used in 92%

of patients in both groups, while the "Chip and Flip"technique was used in the remaining 8% of patients.

Duration:*The mean operation time in group I wasThe mean operation time in group I was

13.48±1.85 minutes in and in group II, it was10.8±3.08 minutes. A statistically significant differencewas found. (p=0.00)*

The mean EPT *in group I was 9.07±9.76 seconds and in group II, it was 7.01±7.09 seconds.

Statistically significant difference was found (p=0.00)*.

The amount of irrigation fluid* used :- in group I (B-MICS) had a mean of 228.8±51.1 mlg p ( )

- in group II (CO-MICS)153.2±42.79 ml.A statistically significant difference was found (p=0.00)*.

No intraoperative complications were recorded in either group.g p

No statistically significant difference was foundNo statistically significant difference was found

(p=0.140), although 8% of patients in group I

had grade 3 corneal oedema in comparison to

0% in group II ..0% in group II ..

The mean BCVA in group I was 0 6880±0 247 and in-The mean BCVA in group I was 0.6880±0.247 and in group II, it was 0.6552±0.287. No statistically significant difference was found (p=0.667). (p )

The mean refractive astigmatic error recorded in-The mean refractive astigmatic error recorded in group I was 1.68±1.19 D and in group II, it was 1.34±0.87 D. No statistically significant difference was y gfound (p= 0.261).

Bi l h d thBimanual phaco can reduce the preexisting astigmatism.

Microcoaxial phaco induces less than a half diopter of astigmatism.

A statistically significant difference was foundA statistically significant difference was found

( P=0.031) as 8% of patients in group I had grade

2 corneal oedema in comparison to 0% in group II

Comparison between specular microscopy parameters (mean ± SD) in both groups one week postoperatively ( ) g p p p y

The parameter Mean ± SD

P valueI II

-Central corneal thickness (T) 0.559±0.041 0.569±0.055 0.452

-Minimal cell size (Min) 214.92±92.168 225.42±62.238 0.644

-Maximal cell size (Max) 1322.52±642.8 2253.46±1968.9 0.030*

-Average cell size (Avg) 548.08±200.39 732.88±419.25 0.053

-Standard deviation (SD) 284.2±135.75 397.5±243.5 0.049*

-Coefficient of variation of cell 50.24±16 67.13±27.59 0.011*size (CV)

0.011

-Cell density (CD) 1961.5±602.72 1747.17±618.4 0.225

- The mean BCVA in group I was 0.8320±0.173 and inThe mean BCVA in group I was 0.8320±0.173 and in group II, it was 0.812±0.217.

No statistically significant difference was found. (p=0 720)(p=0.720).

- The mean refractive astigmatic error recorded in group I was 1.51±1.13 D and in group II, it was 1.19±0.73 D. No statistically significant difference was found

(p = 0.243).(p 0.243).

No statistically significant difference was f d b t th f f th lfound between the mean of any of the specular

microscopy parameters in both group one month postoperativelymonth postoperatively.

Comparison between the mean difference (postoperative-preoperative) results in both groups

No statistically significant difference was found

between any mean difference of any variable in y y

both groups.

SO, to revise my technology now,  

Bimanual phacowith the irrigating chopper from one side and the Bimanual phacowith the irrigating chopper from one side and the phaco handpiecewithout sleeve from other side. 

what happens to the fluidics?

Beads study on the microcoaxial

Not in bimanual

To summarizeWhy microcoaxial Phacoemulsification :1. F M S.

2. Heat production is less (less incidence of wound burn).

3. MICRO COAXIAL surge is less by two thirds than Bi‐MANUAL.

4. Descement's membrane trauma is less.

5 IOP i h hi h i Bi M l th i i l5. IOP is much higher in Bi-Manual than micro-coaxial.

6. Higher volume of fluidics is approved in the Bi-Manual.

7. The cornea is more clear day one than bimanual.

8 The incision of 2 2 mm is astigmatically neutral (less than 2 6 mm)8. The incision of 2.2 mm is astigmatically neutral (less than 2.6 mm).

9. Learning curve is shorer in microcoaxial than bimanual.

• Bimanual phacoemulsification has many advantagesBimanual phacoemulsification has many advantagesthat extend beyond the smaller incision.

It i f t h i ith h t l i• It is a safe technique with a short learning curve oncethe optimum machine parameters and surgicalinstruments are defined.

• With the availability of microincisional IOLs, theprocedure's advantages are even more establishedprocedure s advantages are even more established.These IOLs proved to be simple, efficient and havingexcellent optical properties.

• Combing cool or low ultrasound systems with theprocedure definitely abolishes the fear of cornealwound burn.

• No statistically significant differences were foundbetween the two techniques regarding the

t ti BCVA f ti ti tipostoperative BCVA, refractive astigmatism,surgically induced astigmatism or specularmicroscopy parameters at the end of the follow upperiod.

• No intraoperative complications were reported inNo intraoperative complications were reported ineither group.

The bimanual phaco group had a statistically• The bimanual phaco group had a statisticallysignificant more total operation time and totalamount of irrigation fluid used.

1.8 mm incision, 2.2 mm incision are astigmatic ally neutral incisionsneutral incisions.

IOL insertion could be done through another incision gand astigmatism could be corrected through another incision

Graphic : Hassan ElGraphic : Hassan El--Sheikh Sheikh -- 03 420 55 24 03 420 55 24 . Alex. Egypt. Alex. Egypt