EyeWorld India December 2019 Issue

EWAP DECEMBER 2019 61 DEVICES S urgeons have found a device that helps them surgically treat most cataract patients. William Wiley, MD, has used the miLOOP (Carl Zeiss Meditec), an instrument with a super elastic, nitinol “ˆVÀœw>“i˜Ì ̅>Ì ÜÀ>«Ã around a cataract for centripetal endocapsular nuclear disassembly, for about 2 years and in 500 eyes. The lenses ranged from clear to hypermature cataracts; he’s also used it in complex cases including small pupil and post- vitrectomy eyes. Sumit (Sam) Garg, MD, has used miLOOP for about 1 year and generally reserves it for dense or brunescent cataracts. In dense lenses, “it assures a complete fragmentation of the lens, which can be complicated LÞ «œÃÌiÀˆœÀ LÀˆ`}ˆ˜} wLiÀÃ]» À° Garg said. “Also, because the lens if fragmented, I am able to ÕÃi iÃà «…>Vœ i˜iÀ}Þ°» Dr. Wiley agreed the device can divide the lens in multiple pieces in an atraumatic fashion >œÜˆ˜} vœÀ “œÀi ivwVˆi˜Ì cataract extraction with less phaco energy. He also cited easier lens fragment removal with less chance of capsule rupture or vitreous loss. Susan MacDonald, MD, said another advantage the device has provided is in her instruction of surgeons who do not feel comfortable with «…>Vœi“ՏÈwV>̈œ˜° “It allows doing a divide and conquer phaco without having to go through a lot of time of learning divide and conquer and V…œ««ˆ˜}]» À° >V œ˜>` Ã>ˆ`° “It can be very simply a one- handed technique without using the phaco machine to do the `ˆÛˆ`i >˜` Vœ˜µÕiÀ°» Dr. MacDonald said the device stemmed from an ivvœÀÌ Ìœ w˜` > ÌiV…˜œœ}Þ that would be applicable in low-resource settings, such as where surgeons cannot afford > «…>Vœi“ՏÈwV>̈œ˜ “>V…ˆ˜i° Such settings are where most of her miLOOP experience has come from, although she also has ÕÃi` ˆÌ ܈̅«…>Vœi“ՏÈwV>̈œ˜° “I have used miLOOP on ܓi œv ̅i “œÃÌ `ˆvwVÕÌ cataracts on which I have ever œ«iÀ>Ìi`]» À° >V œ˜>` Ã>ˆ`° “Because they are mature, 5+, 6+ nuclear sclerotic cataracts that have been neglected in />˜â>˜ˆ>°» /…i `iۈVi…i«i` her in such cases. Area for caution The type of cases where Dr. MacDonald has found cause for caution are those with zonular dehiscence that ˆÃ È}˜ˆwV>˜Ì œÀ «Àœ}ÀiÃÈÛi] such as pseudoexfoliation patients who already have some zonular dialysis. Broad usefulness of miLOOP, surgeons say by Rich Daly EyeWorld Contributing Writer Contact information Garg: gargs@uci.edu MacDonald: susanmacdonaldeyecorps@gmail.com Wiley: wiley@cle2020.com This article originally appeared in the September 2019 issue of EyeWorld . +V JCU DGGP UNKIJVN[ OQFKƂGF CPF appears here with permission from the ASCRS Ophthalmic Services Corp. miLOOP placement under anterior capsule. Bisecting the nucleus in half. -œÕÀVi\ -Փ“ˆÌ º->“» >À}]