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Queensland surgeon performs first-of-kind cataract technique   

Gold Coast ophthalmologist Dr Nick Andrew has completed Australia’s first procedure with the Zeiss miLOOP lens fragmentation device, which he believes may offer a superior surgical risk profile over conventional techniques in advanced cataract cases.

Andrew, a cataract and glaucoma specialist who completed one of his fellowships under renowned Canadian ophthalmologist Dr Ike Ahmed, recently performed the new nucleus disassembly technique in Southport, Gold Coast.

“The goal for Zeiss was a complication-free product launch, and I’m pleased that we were able to achieve this. miLOOP is actually very simple to use and the learning curve is not particularly steep,” Andrew, who practises at the Eye and Laser Centre Gold Coast and Gold Coast University Hospital, said.

The technique works to reduce zonular stress.

Andrew believes miLOOP could significantly improve cataract surgery safety, efficiency, and post-operative recovery of vision, particularly in cases of brunescent cataracts.

“It enables us, as eye surgeons, to improve the control, consistency and efficiency of one of the most critical steps of cataract surgery,” he said.

“This device allows the cataract to be divided without ultrasound or laser energy, without fluid irrigation and without sharp instruments inside the eye. Basically, the technology helps to level the playing field for dense cataracts, and it can offer patients faster post-operative recovery of vision by reducing corneal oedema.”

MiLoop is designed to bisect the cataract with minimal zonular stress by using a retractable Nitinol loop to deliver an inward-directed (centripetal) cutting force. This is in contrast to most conventional techniques that fracture the lens with outward-directed (centrifugal) forces and adjunctive phacoemulsification energy.

While ultrasound energy is still required to extract the lens fragments, Andrew said miLOOP has been reported to reduce the total amount of ultrasound energy and fluid irrigation required to remove the cataract.

“The advantages will be greatest for dense cataracts and for surgeons whose conventional cataract technique involves sculpting a trench in the lens. I expect that some surgeons will switch to using miLOOP for most cases to help them achieve greater consistency, efficiency, safety, and a reduction in post-op corneal oedema,” he said.

The device has a retractable loop to deliver an inward-directed cutting force.

Andrew said his standard cataract technique is direct vertical chop, which requires very low levels of ultrasound energy. However, perfecting this technique requires many hundreds of cases and a skilled teacher.

“In contrast, you could do 50 miLOOP cases and very quickly be quartering lenses within a minute with no phaco energy,” he said.

“From an efficiency point of view, a surgeon could turn their brunescent cataract cases from a 40 minute procedure that they are sweating over because they are putting a lot of energy into the eye, to potentially another 10 to 15 minute case with only modest amounts of energy. So it has potential for many surgeons.”

According to Zeiss, in a 2019 surgeon survey, the majority of trained Zeiss miLOOP surgeons reported a perceived reduction in overall procedure time.

It also reported that a 2018 randomised controlled study in the British Journal of Ophthalmology showed that using miLOOP in hard grade 3-4+ nuclear cataracts reduced phaco energy by up to 53% and lowered the surgical irrigation fluid volume used per case by over 20%.

MiLOOP was developed by US ophthalmologist Dr Sean Ianchulev and commercialised internationally by IanTECH in 2018. Zeiss acquired IanTECH in 2018 and is now distributing the device in Australia.

Andrew has no financial interests in miLOOP or Zeiss to declare.

 

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