Breyer.qxp 24/9/08 12:31 Page 22
Surgery Cataracts
Figure 1: The Evolution of Oertli Tips
Prejudice 4 – ‘The Chamber Stability of a Small Tip
Is Worse Than for a Larger Tip’
This is not the case, because according to Table 2 the CO-MICS 2 tip
shows better anterior chamber (AC) stability in all vacuum settings, and
the required 100–150mmHg increase in vacuum pressure results in the
same AC stability as conventional phaco.
In addition to the advantages of an astigmatism-free incision and excellent
phacodynamics, I would like to point out some positive clinical observations
19G 20G CO-MICS 1 CO-MICS 2
I experienced as a first-time user, which I have shared on various occasions
Figure 2: Pentacam Keratography Before and After Co-axial
with the following colleagues: S Binder (Vienna), J Bolger (London),
Micro-incision Surgery (CO-MICS) with the CO-MICS 2 T Burton (Norwich), S Chawla (Lucknow), A Dosso (Geneva), A Gandorfer
(Munich), J Garweg (Bern), S Haldipurkar (Mumbai), B Marcon
(Monfalcone), R Menapace (Vienna) and Ch Prünte (Vienna).
First, the flat AC aids in small pupil surgery: due to the reduced CO-MICS
2 tip diameter and size, the surgeon’s view is much less obstructed. The
surgeon can thus avoid pupillary stretching, and the flat AC also means
the surgeon has more room in which to manoeuvre.
Second, the smaller incision size results in a more stable post-operative
wound, which is important for the following clinical situations:
endophthalmitis; vitrectomised or highly myopic ‘floppy’ eyes; peripheral
corneal degenerations; combined cataract and ppvitrectomy surgery; and
when a clear cornea incision is needed, such as as in cataract surgery after
glaucoma filtrating procedures or for ocular surface disorders.
Third, in modern phacorefractive surgery the implantation of toric IOLs is
Figure 3: Oertli CO-MICS 1 – Traditional Design
a routine procedure. We published the first results of the implantation of
toric, bifocal IOLs at this year’s DOC meeting in Nuremberg. For both toric
and toric, bifocal IOLs – and especially for the latter – the predictability of
the surgical outcome is essential for patient satisfaction and can be
Ø 1.25
Ø 0.7
guaranteed only with careful pre-operative keratoscopy and biometry
together with astigmatism-free surgery.
30°
Taking all of this into account, by using the Oertli OS3 system surgeons
will be well equipped for innovative, effective and safe cataract surgery.
Figure 4: Oertli CO-MICS 2 – Smart Design
Posterior Segment Surgery – Transconjunctival Autoseal
23G PPVitrectomy and High-speed Cutting
When Oertli’s research and development (R&D) manager Silvio Di Nardo
Ø 1.25 Ø 0.95
announced the first instrumentation for 23 and 25G surgery years ago, I
was very excited about this new method. I reserved 15 more minutes
53°
than a normal time slot (30–45 minutes) in my surgical plan for combined
cataract surgery and membrane peeling for macular pucker surgery. After
30–45 minutes I completed the surgery and was amazed at how easy and
Figure 5: Cross-sectional Area A Defined by Outermost and patient-friendly this new method was: no conjunctival preparation, no
Innermost Diameter
sutures, easy handling and a nearly sensation-free procedure, with
A
patients having white eyes the first day post-operatively. I have to stress
that I completed only one case with the 25G system, because I did not
Ø 0.4
like the prolonged surgical time in comparison with 23G surgery, nor the
higher flexibility of the 25G instruments.
Ø 0.95
Two technical challenges Oertli shared with other 23G systems remained:
B
prolonged vitreous removal time or loss of efficiency in aspiration, and
leakage through the pilot tubes. The prolonged vitreous removal time or loss
1.4
of efficiency in aspiration, as well as vitreoretinal traction, was significantly
0.
8
4
reduced with the introduction of a high-speed cutting vitrectome with
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