EyeWorld India March 2018 Issue

50 EWAP DEVICES March 2018 miLOOP miLOOP (Iantech, Reno, Nevada) is an endocapsular, nitinol ring that acts like a snare that bisects the cataract and chops the cataract into smaller pieces. “It’s also an alternative or supplement to the femtosecond laser that can be used in complex cataracts, such as very dense cataracts,” said William Wiley, MD, Cleveland. “One of its unique advantages is that it truly bisects the cataract from equator to equator, even behind a small pupil. In contrast, the femtosec- ond can only laser what it sees. So even with a femtosecond laser, when you use softening mode, you don’t get a full softening or a full dissection of the cataract. The miLoop bisects the cataract completely in half from equator to equator and even smaller pieces if you deploy it multiple times.” It has the ability to make the surgery easier by dismantling the lens and mobilizing the fragment- ed pieces making them easier to aspirate. It also decreases ultra- sound energy levels inside the eye in denser cataracts which allows for faster healing and fewer com- plications. “I see this being applied in a number of different ways,” Dr. Wiley said. “It could be applied for complex cases. For example, if there is a dense cataract and you need to make the case easier by bisecting it, the miLOOP can be used there. Furthermore, it can be utilized in premium cases when you’re looking for faster healing and a safer procedure with fewer complications. I believe doctors will find surgical cases to be easier and that they’ll be more confident when using the device. Thus, they may choose to use it in all their premium cases. Some doctors may find a use in all cases, if they’re looking to be more efficient or provide improved visual recovery. There is a disposable cost to this; however, it can be offset by surgi- cal efficiency saving surgeon and staff time.” Susan MacDonald, MD, Peabody, Massachusetts, is us- ing miLOOP in a new technique with a 4-mm scleral tunnel for global outreach. “It’s easy to teach miLOOP to surgeons who need cataract experience,” she said. “I’ve designed a new technique. Using the miLOOP, I will divide the nucleus into two to four pieces and twist my hand to the right or left, which will help me deliver the nucleus into the anterior cham- ber. Then I will use a lens loop to deliver the nucleus out of the anterior chamber. Depending on how many pieces I cut the nucleus into, I’m able to reduce the size of the small incision extracap inci- sion down to about 5 mm, which I think is significant.” According to Dr. Packard, the price for miLOOP will be about US$100. “It remains to be seen how well the market will respond to this. I suspect it will only be used in more challenging hard nuclei,” he said. Learning curve These devices eliminate the capsulorhexis, which is the most difficult part of cataract surgery, so the learning curve is not steep. “One of the immediate mar- kets that I would be going after is the VA because most of the cataract surgery at the VA is done by residents,” Dr. Packer said. “They’re early in their learn- ing curve, and they experience complications. Complications cost time and money, and no one likes that. I could see replacing the cap- sulorhexis with a capsulotomy in a context like that, where primarily residents are doing the surgery. When they graduate and go on to practice, that’s what they will use. However, if you’re really skilled in performing a capsulorhexis, this takes more time and costs more money.” EWAP Editors’ note: Dr. Packard has financial interests with Excellens (Los Gatos, California). Dr. Packer has financial interests with ApertureCTC. Dr. Wiley has financial interests with Iantech. Dr. MacDonald has no financial interests related to her comments. Contact information MacDonald: susan.m.macdonald@ lahey.org Packard: eyequack@vossnet.co.uk Packer: mark@markpackerconsulting. com Wiley: kpiroch@clevelandeyeclinic.com A CAPSULaser device attached under an operating microscope. Source: Richard Packard, MD This image of the miLOOP shows the loop deployed in the open position, which can be retracted or closed with the nger lever, resulting in an ef cient and effective modality to transect the nucleus. Source: William Wiley, MD New devices - from page 49