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

Explore the safety and efficiency of Pulse and Continuous ultrasound modes in bimanual micro incision cataract surgery. Results show comparable outcomes in cornea edema, complication rates, phaco time, and incision sealing.

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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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