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Comparison of two differents ultrasound mode in BMICS technique : Pulse and Continuous US

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.

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Comparison of two differents ultrasound mode in BMICS technique : Pulse and Continuous US

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  1. 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

  2. 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

  3. METHODS • Prospective study • Same surgeon • Stellaris™ system (Bausch + Lomb) • Bimanual MICS (2 incisions of 1.3mm) • Handpiece 28,5Khz • 90 patients (90 eyes) • Two groups : • Group 1 : 45 patients, US mode Pulse • Group 2 : 45 patients, US mode Continuous.

  4. CRITERIA ANALYSED • Cornea edema post op D1 • 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 D1 – D8 • Nucleus density : grade 2, 3 or 4 • Balanced salt solution volume used during surgery

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

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

  7. RESULTS BSS VOLUME CORNEA EDEMA Post op D1 • Group 1 (US pulses): • 2 edemas moderate • Group 2 (US continuous): • 1 edema moderate COMPLICATION DURING SURGERYGroup 1 (US pulses) :Nothing to reportGroup 2 (US continuous) :Nothing to report • Group 1 ( US pulses): • BSS(ml): 39 ± 10,3 • Group 2 ( US continuous): • BSS(ml): 37 ± 6,3 P=0,25 ns INCISION LEAKAGE D1 & D8 • In both group, no leak at the incision at D1 and D8.

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

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

  10. IN SUMMARY • As expected the US delivery is more important in group 2 (US continuous) • In both group: • No complication during surgery • 2 moderateedemas in group 1, 1 moderateedemas in group 2 • Incisions are tight at D1 & D8 • No statiscally significant difference between both group for endothelial cell loss • Distinction between both group in term of UDVA & CDVAare not clinically significant • BSS volume used is equivalent

  11. 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 (28,5Khz) 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.

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