Evaluation of clinical outcomes following implantation of a sub-2-mm hydrophilic acrylic MICS intraocular lens

  • H. Burkhard Dick
  • Tim Schultz
  • Gilles Lesieur
  • Simonetta Morselli
  • Antonio Toso
  • Jorge L. Alio
  • Phillip J. Buckhurst
  • Björn Johansson
Original Paper



To evaluate clinical outcomes following sub-2-mm microincision cataract surgery (MICS) and intraocular lens (IOL) implantation.


Five EU clinical sites.


Prospective, multicenter, open-label, single-arm, non-randomized.


Preoperative assessment involved visual acuity (VA), intraocular pressure and biometry measurements. 1.4-mm wound-assisted or 1.8-mm MICS was performed. Follow-up visits were made 1 day, 1–2 weeks, 1–2 and 4–6 months after surgery. The incision size, corrected distance VA (CDVA), uncorrected distance VA, manifest refraction spherical equivalent (MRSE), refraction predictability/stability and IOL decentration were assessed. At 12-, 18-, and 24-month, long-term centration, posterior capsular opacification (PCO) and Nd:YAG capsulotomy rates were investigated.


A total of 103 eyes were implanted with the study IOL (INCISE, Bausch & Lomb), 96 of which were included in visual outcome analysis. A mean 6-month CDVA of − 0.02 logMAR (20/20 + 1) was observed and 75 eyes (79.8%) and 93 eyes (98.3%) achieved a visual acuity of at least 20/20 or 20/40. Mean MRSE was − 0.20 ± 0.60 D. Mean absolute predictive error was 0.44 ± 0.36 D, with 90.4% within 1.00 D of target. Mean total decentration was 0.35 ± 0.36 mm at 6 months and 0.32 ± 0.14 mm at 24 months (p > 0.05). 24-month evaluation of posterior capsular opacification score was 0.03 for the central area. A Nd:YAG rate of 3.4% was observed at 24 months.


The new MICS IOL provided excellent visual outcomes and was safe and effective for the sub-2-mm procedure. The MICS IOL demonstrated long-term centration, stability and a low rate of PCO development.


Intraocular lens Implantation Microincision cataract surgery 


Author contribution

The authors confirm that they have made a significant contribution to this study and have read and approved the final version of the manuscript.


This clinical research was initiated and financially supported by Bausch & Lomb. None of the authors have a financial or proprietary interest in any material or method mentioned in this paper. Dr Johansson, Prof Dick, Dr Morselli, Dr Toso received travel support for scientific meetings.

Compliance with ethical standards

Conflict of interest

There are no conflicts of interest to disclose.

Ethical approval

All procedures performed in this study were in accordance with the ethical standards of the institutional research committee and with the 1964 Helsinki Declaration and its later amendments.

Informed consent

Informed consent was obtained from all individual participants included in the study.


  1. 1.
    Klonowski P, Rejdak R, Alió JL (2013) Microincision cataract surgery 1.8 mm incisional surgery. Expert Rev Ophthalmol 8(4):375–391CrossRefGoogle Scholar
  2. 2.
    Yu JG, Zhao YE, Shi JL, Ye T, Jin N, Wang QM, Feng YF (2012) Biaxial microincision cataract surgery versus conventional coaxial cataract surgery: meta-analysis of randomized controlled trials. J Cataract Refract Surg 38:894–901CrossRefPubMedGoogle Scholar
  3. 3.
    Agarwal A, Agarwal S, Agarwal A, Bagmar A, Patel N, Pandey SK, Shah SP (2001) Phakonit lens removal through a 0.9 mm incision [letter]. J Cataract Refract Surg 27:1531–1532 (reply by H Tsunoka, 1532–1533) CrossRefPubMedGoogle Scholar
  4. 4.
    Tsuneoka H, Shiba T, Takahashi Y (2002) Ultrasonic phacoemulsification using a 1.4 mm incision: clinical results. J Cataract Refract Surg 28:81–86CrossRefPubMedGoogle Scholar
  5. 5.
    Alio JL, Rodriguez Prats JL, Galal A (eds) (2004) MICS: micro-incision cataract surgery. Highlights of Ophthalmology International, El Dorado, PanamaGoogle Scholar
  6. 6.
    Dick HB (2012) Controlled clinical trial comparing biaxial microincision with coaxial small incision for cataract surgery. Eur J Ophthalmol 22:739–750CrossRefPubMedGoogle Scholar
  7. 7.
    Alio JL, Rodrıguez-Prats JL, Galal A, Ramzy M (2005) Outcomes of microincision cataract surgery versus coaxial phacoemulsification. Ophthalmology 112:1997–2003CrossRefPubMedGoogle Scholar
  8. 8.
    Elkady B, Alio JL, Ortiz D, Montalban R (2008) Corneal aberrations after microincision cataract surgery. J Cataract Refract Surg 34:40–45CrossRefPubMedGoogle Scholar
  9. 9.
    Hayashi K, Hayashi H, Nakao F, Hayashi F (1995) The correlation between incision size and corneal shape changes in sutureless cataract surgery. Ophthalmology 102:550–556CrossRefPubMedGoogle Scholar
  10. 10.
    American National Standards Institute (2010) ANSI Z80.30—2010: ophthalmics—toric intraocular lenses. American National Standards Institute, New York, p 2010Google Scholar
  11. 11.
    International Organization for Standardization (2006) ISO 11979-7:2006(E) ophthalmic implants—intraocular lenses—Part 7: clinical investigations, 2006. International Organization for Standardization, GenevaGoogle Scholar
  12. 12.
    Lundström M, Barry P, Henry Y, Rosen P, Stenevi U (2012) Evidence-based guidelines for cataract surgery: guidelines based on data in the European Registry of Quality Outcomes for Cataract and Refractive Surgery database. J Cataract Refract Surg 38:1086–1093CrossRefPubMedGoogle Scholar
  13. 13.
    ULIB User group for laser interference biometry. Accessed 22 March 2015
  14. 14.
    Klonowski P, Rejdak R, Alio JL (2013) Microincision cataract surgery: 1.8 mm incisional surgery. Expert Rev Ophthalmol 8:375–391CrossRefGoogle Scholar
  15. 15.
    Wilczynski M, Supady E, Loba P, Synder A, Palenga-Pydyn D, Omulecki W (2009) Comparison of early corneal endothelial cell loss after coaxial phacoemulsification through 1.8 mm microincision and bimanual phacoemulsification through 1.7 mm microincision. J Cataract Refract Surg 35:1570–1574CrossRefPubMedGoogle Scholar
  16. 16.
    Gale RP, Saldana M, Johnston RL, Zuberbuhler B, McKibbin M (2009) Benchmark standards for refractive outcomes after NHS cataract surgery. Eye (Lond) 23:149–152CrossRefGoogle Scholar
  17. 17.
    Baumeister M, Buehren J, Kohnen T (2009) Tilt and decentration of spherical and aspheric intraocular lenses: effect on higher order aberrations. J Cataract Refract Surg 35:1006–1012CrossRefPubMedGoogle Scholar
  18. 18.
    Buckhurst PJ, Woffsohn JS, Naroo SA, Davies LN (2010) Rotational and centration stability of an aspheric intraocular lens with a simulated toric design. J Cataract Refract Surg 36:1523–1528CrossRefPubMedGoogle Scholar
  19. 19.
    Wolffsohn JS, Buckhurst PJ (2010) Objective analysis of toric intraocular lens rotation and centration. J Cataract Refract Surg 36:778–782CrossRefPubMedGoogle Scholar
  20. 20.
    Crnej A, Hirnschall N, Nishi Y et al (2011) Impact of intraocular lens haptic design and orientation on decentration and tilt. J Cataract Refract Surg 37:1768–1774CrossRefPubMedGoogle Scholar
  21. 21.
    Xing XJ, Tang X, Song H (2012) Comparison of optical performance and stability of five different kinds of aspheric IOLs. Zhonghua Yan Ke Za Zhi 48:297–301PubMedGoogle Scholar
  22. 22.
    Nishi O, Nishi K (1999) Preventing posterior capsule opacification by creating a discontinuous sharp bend in the capsule. J Cataract Refract Surg 25:521–526CrossRefPubMedGoogle Scholar
  23. 23.
    Nishi O, Nishi K, Sakanishi K (1998) Inhibition of migrating lens epithelial cells at the capsular bend created by the rectangular optic edge of a posterior chamber intraocular lens. Ophthalmic Surg Lasers 29:587–594PubMedGoogle Scholar
  24. 24.
    Nishi O, Nishi K, Osakabe Y (2004) Effect of intraocular lenses on preventing posterior capsule opacification: design versus material. J Cataract Refract Surg 30:2170–2276CrossRefPubMedGoogle Scholar
  25. 25.
    Buehl W, Findl O (2008) Effect of Intraocular lens design on posterior capsule opacification. J Cataract Refract Surg 34:1976–1985CrossRefPubMedGoogle Scholar
  26. 26.
    Findl O, Buehl W, Bauer P, Sycha T (2010) Interventions for preventing posterior capsule opacification. Cochrane Collab 2010:1–81Google Scholar
  27. 27.
    Werner L, Müeller M, Tetz M (2008) Evaluating and defining the sharpness of intraocular lenses: microedge structure of commercially available suare-edged hydrophobic lenses. J Cataract Refract Surg 34:310–317CrossRefPubMedGoogle Scholar
  28. 28.
    Werner L, Tetz M, Feldmann I, Bücker M (2009) Evaluating and defining the sharpness of intraocular lenses: microedge structure of commercially available square-edged hydrophilic intraocular lenses. J Cataract Refract Surg 35:556–566CrossRefPubMedGoogle Scholar
  29. 29.
    Nanavaty MA, Spalton DJ, Boyce J, Brain A, Marshall J (2008) Edge profile of commercially available square-edged intraocular lenses. J Cataract Refract Surg 34:677–686CrossRefPubMedGoogle Scholar
  30. 30.
    Roshdy MM, Riad RF, Morkos FF, Hassouna AK, Wahba SS (2013) Effect of a single-piece aspheric hydrophobic acrylic intraocular lens design on centration and rotation. J Cataract Refract Surg 39:408–413CrossRefPubMedGoogle Scholar
  31. 31.
    Miyata K, Kataoka Y, Matsunaga J, Honbo M, Minami K (2015) Prospective comparison of one-piece and three-piece Tecnis aspheric intraocular lenses: 1-year stability and its effect on visual function. Curr Eye Res 40:930–935CrossRefPubMedGoogle Scholar
  32. 32.
    Johansson B (2010) Clinical consequences of acrylic intraocular lens material and design: Nd:YAG-laser capsulotomy rates in 3 × 300 eyes 5 years after phacoemulsification. Br J Ophthalmol 94:450–455CrossRefPubMedGoogle Scholar
  33. 33.
    Zacharopoulos IP, Papadaki T, Segev F, Jager-Roshu S, Assia E (2010) Two-year results of cataract extraction with implantation of the hydrophilic acrylic B-lens. Semin Ophthalmol 25:1–7CrossRefPubMedGoogle Scholar
  34. 34.
    Gauthier L, Lafuma A, Laurendeau C, Berdeaux G (2010) Nd:YAG laser rates after bilateral implantation of hydrophobic or hydrophilic multifocal intraocular lenses: twenty-four month retrospective comparative study. J Cataract Refract Surg 36:1195–1200CrossRefPubMedGoogle Scholar
  35. 35.
    Iwase T, Nishi Y, Oveson BC, Jo YJ (2011) Hydrophobic versus double-square-edged hydrophilic foldable acrylic intraocular lens: effect on posterior capsule opacification. J Cataract Refract Surg 36:1060–1068CrossRefGoogle Scholar
  36. 36.
    Spyridaki PM, Hoeh H (2010) Comparison of four MICS intraocular lenses regarding their rates of neodymium:YAG laser capsulotomy. Klin Monatsbl Augenheilkd 227:208–214CrossRefPubMedGoogle Scholar
  37. 37.
    Selvam S, Khan IJ, Craig EA (2011) Neodymium:YAG laser capsulotomy rate of microincision hydrophilic acrylic intraocular lens. J Cataract Refract Surg 37:2080–2081CrossRefPubMedGoogle Scholar
  38. 38.
    Alió JL, Elkady B, Ortiz D (2011) Corneal optical quality following sub 1.8 mm micro-incision cataract surgery vs. 2.2 mm mini-incision coaxial phacoemulsification. Middle East Afr J Ophthalmol 17:94–99Google Scholar
  39. 39.
    Tong N, He JC, Lu F, Wang Q, Qu J, Zhao YE (2008) Changes in corneal wavefront aberrations in microincision and small-incision cataract surgery. J Cataract Refract Surg 34:2085–2090CrossRefPubMedGoogle Scholar
  40. 40.
    Can I, Bayhan HA, Çelik H, Ceran BB (2012) Comparison of corneal aberrations after biaxial microincision and microcoaxial cataract surgeries: a prospective study. Curr Eye Res 37:18–24CrossRefPubMedGoogle Scholar
  41. 41.
    Denoyer A, Denoyer L, Marotte D, Georget M, Pisella PJ (2008) Intraindividual comparative study of corneal and ocular wavefront aberrations after biaxial microincision versus coaxial small-incision cataract surgery. Br J Ophthalmol 92:1679–1684CrossRefPubMedGoogle Scholar

Copyright information

© Springer Science+Business Media B.V., part of Springer Nature 2018

Authors and Affiliations

  • H. Burkhard Dick
    • 1
  • Tim Schultz
    • 1
  • Gilles Lesieur
    • 2
  • Simonetta Morselli
    • 3
  • Antonio Toso
    • 3
  • Jorge L. Alio
    • 4
  • Phillip J. Buckhurst
    • 5
  • Björn Johansson
    • 6
    • 7
  1. 1.University Eye Hospital BochumBochumGermany
  2. 2.Centre Ophtalmologique IridisAlbiFrance
  3. 3.Ospedale di Bassano del Grappa Bassano del GrappaBassano del GrappaItaly
  4. 4.Vissum-Instituto Oftalmologico de AlicanteUniversity Miguel HernandezAlicanteSpain
  5. 5.School of Health ProfessionsPlymouth UniversityPlymouthUK
  6. 6.Department of Ophthalmology and Department of Clinical and Experimental MedicineLinköping UniversityLinköpingSweden
  7. 7.St. Erik Eye HospitalStockholmSweden

Personalised recommendations