title: Comparative outcomes of bimanual MICS and 2.2-mm coaxial phacoemulsification assisted by femtosecond technology.
abstract: OBJECTIVE
  To compare the efficacy and safety outcomes of bimanual microincision cataract surgery (MICS) versus 2.2-mm coaxial phacoemulsification assisted by Femtosecond LenSx (Alcon-LenSx Inc., Aliso Viejo, CA).
  
  
  METHODS
  This prospective, randomized, observational, comparative case series comprised 50 cataractous eyes of 50 patients receiving femtosecond laser refractive lens surgery followed by a bimanual MICS technique with two 1-mm incisions (25 patients) (FemtoMICS group) and a coaxial phacoemulsification technique with a 1-mm paracentesis and a 2.2-mm principal incision (25 patients) (FemtoCoaxial group). The main outcomes measures were: ultrasound power, effective phacoemulsification time, postoperative spherical equivalent, higher-order aberrations (corneal and internal), corneal thickness, endothelial cell count, macular thickness, and complications during and after surgery. Both groups were absolutely comparable for all variables preoperatively.
  
  
  RESULTS
  Mean ultrasound power was 1.8% ± 0.9% for MICS and 14.7% ± 4.9% for 2.2-mm incisions (P < .001). Effective phacoemulsification time values for MICS and 2.2-mm incisions were 1.5 ± 0.9 and 4.5 ± 2.9 sec, respectively (P = .002). Mean postoperative spherical equivalent was −0.26 for FemtoMICS and −0.33 for FemtoCoaxial (P > .05). The efficacy index at 1 month postoperatively was 160.2% for FemtoMICS and 149% for FemtoCoaxial. No significant differences were found in corneal thickness, endothelial cell count, and macular thickness. Complications included posterior capsule rupture (4%) and anterior capsule rupture with no posterior capsule tear (4%) for FemtoMICS and bridges due to incomplete capsulorhexis (4%) for FemtoCoaxial.
  
  
  CONCLUSIONS
  MICS and coaxial phacoemulsification techniques assisted by the Femtosecond LenSx achieved excellent safety and efficient outcomes. The FemtoMICS technique was surgically and statistically more efficient than the FemtoCoaxial technique.
authors.forename: Jorge L
authors.initials: JL
authors.lastname: Alió
authors.forename: Felipe
authors.initials: F
authors.lastname: Soria
authors.forename: Ahmed A
authors.initials: AA
authors.lastname: Abdou
authors.forename: Pablo
authors.initials: P
authors.lastname: Peña-García
authors.forename: Roberto
authors.initials: R
authors.lastname: Fernández-Buenaga
authors.forename: Jaime
authors.initials: J
authors.lastname: Javaloy
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D002452:Cell Count; D004728:Endothelium, Corneal / Q000473:pathology; D005260:Female; D006801:Humans; D053685:Laser Therapy / Q000379:methods*; D019654:Lens Implantation, Intraocular; D008297:Male; D008866:Microsurgery / Q000379:methods*; D008875:Middle Aged; D018918:Phacoemulsification / Q000379:methods*; D011446:Prospective Studies; D019591:Pseudophakia / Q000503:physiopathology; D013997:Time Factors; D016896:Treatment Outcome; D014792:Visual Acuity / Q000502:physiology