Cataract is a common age-related blinding eye disease, and 80% of the elderly over 60 years old suffer from cataract of varying severity. After suffering from cataract, there will be obvious vision loss, blurred vision, photophobia and other symptoms, and even lead to blindness in severe cases, which brings a lot of inconvenience to the life of the elderly.
Although phacoemulsification cataract surgery has become a world-recognized, advanced and mature surgical method, how to protect the suspensory ligament while reducing the release of ultrasound energy during surgery to protect the corneal endothelium has always been the goal of ophthalmologists around the world. As a leading ophthalmology center in China, Professor Wu Xiaoming is one of the first ophthalmologists in China to use the Miloop nucleocrizer. Recently, he used the Miloop zero-energy nucleus crusher, which is known as the "black technology" in the cataract field, to complete phacoemulsification surgery for a patient with grade VI nucleus.
Schematic diagram of miloop
Miloop is an ultra-fine ring-shaped, disposable "nuclear splitter" made of 300 m thick nitinol memory alloy. Its minimum shrinkage diameter is 15mm, the maximum diameter of expansion can reach 12mm, and the shear force when shrinking is enough to split the hard core.
The miloop can enter the eye through a small incision, and split the lens nucleus into small pieces under the release of zero ultrasound energy, so as to achieve zero ultrasound energy nucleus fragmentation, effectively reduce the corneal endothelial damage in ultramammary cataract surgery, and protect the suspensory ligament through centrinal nucleus crush, making cataract surgery safer.
What are the benefits of using miloop for patients?
1.Zero ultrasound energy of nucleus fragmentation and protection of corneal endothelial cells can effectively reduce the release of ultrasound energy and reduce the loss rate of corneal endothelial cells. A prospective randomized controlled study [1] showed that the Miloop-assisted phacoemulsification group significantly reduced the cumulative intraoperative ultrasound energy (CDE) and reduced the rate of corneal endothelial cell loss by 16% at 1 month after surgery compared with the traditional ultraemulsification group.
As shown in the figure (left and right): the intraoperative ultramammary parameters and postoperative complications of the two groups.
2.Centripetal nucleus crush, which protects the lens suspensory ligament, and traditional phacoemulsification surgery has obvious traction on the lens suspensory ligament; The miloop is a centripetal nucleus fragment without any traction on the crystal suspensory ligament. The first study using miloop [2] found that miloop performed lens segmentation without any ultrasound energy or femtosecond assistance, and that all cases were fully minterclamated with miloop-assisted full-thickness nucleation without complications, and no patient had more than 3 minutes of nucleation time, and miloop was observed to minimize traction of the capsular pouch and crystal suspensory ligament.
3.A clinical study published in the journal J Cataract Refract Surg in 2020 [3] showed that the refractive error was less than 0 in the Miloop group after surgeryThe ratio of 25 d is 918%。
Postoperative refractive error in the two groups).
4.A retrospective continuous case study [4] showed that compared with the traditional group, Miloop-assisted phacoemulsification surgery reduced the total phacoemulsification time by 42% and the total perfusion suction time by 54%, greatly improving the surgical efficiency.
As shown in the figure (left and right): total supermammation time and total perfusion suction time in the two groups.
Miloop case.
The patient, Ms. Li, 55 years old, has a history of high myopia in both eyes, and the myopia degree is nearly 2000 degrees, and she underwent "retinal tear repair and vitrectomy surgery in the left eye" in the hospital for nearly 2-3 years due to high myopia and fundus lesions.
After consultation and communication with the doctor, Ms. Li completed various preoperative examinations in the hospital, and the results of various examinations met the requirements of cataract surgery.
One week after the operation, Ms. Li went to the hospital for a follow-up examination, and her vision recovered well after the operation, and the endothelial examination showed that the corneal endothelial damage was small, the lens was in position, and the cornea was transparent.
Because the patient's vision was too poor to take care of himself at the time of admission, he is now recovering well after surgery, and the patient and his family are satisfied with the results of the operation.
Director Wu Xiaoming said: "People may experience more than one eye surgery in their life, and every operation may cause irreversible damage to the corneal endothelium, and human corneal endothelial cells are non-renewable, so every ophthalmologist should minimize corneal endothelial damage as a continuous goal, so cataract surgery needs to be refined, especially refractive cataract surgery, and with the help of Miloop nucleation crusher, zero energy can be achieved Reduce the damage of ultrasound energy to the patient's corneal endothelium. ”
References: 1] Ianchulev T, Chang DF, Koo E, MacDonald S, Calvo E, Tyson FT, Vasquez A, Ahmed IIK microinterventional endocapsular nucleus disassembly: novel technique and results of first-in-human randomised controlled study. br j ophthalmol. 2019 feb;103(2):176-180.
2] ianchulev t, chang df, koo e, macdonald s. microinterventional endocapsular nucleus disassembly for phacoemulsification-free full-thickness fragmentation. j cataract refract surg. 2018 aug;44(8):932-934.
3] roper gj, hoffer kj, pamnani rd. effect of microinterventional endocapsular nucleus disassembly using centripetal loop fragmentation on refractive outcomes after cataract surgery. j cataract refract surg. 2020 nov;46(11):1515-1521.
4] wiley wf, bafna s, logothetis hd. comparative study of phacoemulsification parameters with and without nitinol filament nuclear disassembly. j cataract refract surg. 2021 aug 1;47(8):1028-1031.