EyeWorld Asia-Pacific September 2018 Issue

by Liz Hillman EyeWorld Senior Staff Writer First-in-human randomized controlled study compares phaco time with miLOOP and phaco alone 26 EWAP CATARACT/IOL September 2018 Researchers evaluated the ef cacy of miLOOP in dense, mature cataract cases compared to traditional phacoemulsi cation. Source: Sean Ianchulev, MD Micro-interventional nucleus disassembly with miLOOP resulted in significantly less phaco energy in moderate to advanced cataract I t has been a year since miLOOP (Iantech, Reno, Nevada), an instrument with a superelastic, nitinol microfilament that wraps around a cataract for centripetal endo- capsular nuclear disassembly, was introduced. Susan MacDonald, MD , as- sociate professor, Tufts University School of Medicine, Boston, said she uses it as her “go-to instru- ment” for difficult cases, including small pupils, zonular instability, hard cataracts, and even soft pre- mium lens cataracts. “It has improved my surgical time and my technique. This de- vice makes a cases easier, and I use less phaco energy, which ultimate- ly results in a better outcome for the patient,” Dr. MacDonald said. Dr. MacDonald was one of the investigators on the first-in-human randomized, prospective clinical trial to compare phacoemulsifica- tion alone vs. phaco and prefrag- mentation of dense cataracts with miLOOP, published in the British Journal of Ophthalmology . 1 One hundred and one eyes with grade 3–4+ nuclear cataracts were randomized to either undergo torsional phacoemulsification or prefragmentation with miLOOP followed by torsional phacoemul- sification. The mean cumulative dispersed energy was 53% higher in the phaco alone group, while endothelial cell loss was similar between the two groups, Ianchulev et al. wrote. “We’re showing that in the hands of great surgeons, very experienced choppers, and with the top-of-the-line, latest equip- ment with torsional ultrasound, you can dramatically reduce heat and energy delivered to the eye by using the miLOOP,” said Sean Ianchulev, MD , professor of oph- thalmology, New York Eye and Ear Infirmary, Icahn School of Medi- cine, New York, and co-founder of the miLOOP technology and Iant- ech. “Unlike femto and lasers that do prepare the lens … [miLOOP] is a simple, hand-held instrument that uses no energy to prepare the lens to segment it and make phaco easier.” Though time of the surgical cases was not recorded as an out- come measure, Dr. Ianchulev said the use of miLOOP did not length- en the procedure. Dr. MacDonald, who said she uses miLOOP for complicated cases outside of this study, said it makes the procedure more efficient, safer, and ultimate- ly faster. In addition to this paper, Dr. Ianchulev noted that Iantech introduced biLOOP, a two-filament multiloop for nuclear fragmenta- tion, at the 2018 ASCRS•ASOA Annual Meeting. There were al- most a dozen peer-reviewed paper presentations at the ASCRS•ASOA Annual Meeting on miLOOP; two were awarded Best Paper of Session awards. These included one that looked at nuclear disassembly with miLOOP in 4–4+ cataracts and another that discussed outcomes of “minicap,” manual small incision cataract surgery (MSICS) with a 5.0 mm incision made possible due to nuclear disassembly with miLOOP. As executive director of Eye Corps, a nonprofit organization, Dr. MacDonald said she is teaching and using the instrument while working in Tanzania, where almost all of the cataracts she’s seeing are grades 3 and above. “I’m using miLOOP exclusively when I’m operating,” she said, not-