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Difference Between Micro-Incision Cataract Surgery (MICS) and Phacoemulsification

Cataracts are a common condition that can cloud your vision, often making everyday tasks seem difficult or even impossible. Thanks to advancements in ophthalmology, surgeries to remove cataracts have become safer and more effective than ever before.

If you’re researching cataract surgery options, you’ve likely come across two terms repeatedly: Micro-Incision Cataract Surgery (MICS) and Phacoemulsification. But what’s the difference? Which option might be better for you?

I’m Dr Advaith Sai Alampur, and as an ophthalmologist, I’ve guided countless patients toward clearer vision through these procedures.

Today, we’ll break down everything you need to know about MICS and Phacoemulsification, so you can feel confident in understanding your options.

AUTHOR

Ophthalmologist/ Eye Surgeon 13+ Years Exp

MBBS, MS – Ophthalmology

TSMC- TSMC/FMR/05251 (2018)

CONDITION

Cataract

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Understanding the Basics of Cataract Surgery

Before we get into the details, it’s important to understand what cataract surgery entails. The goal is to remove the clouded lens (cataract) in your eye and replace it with a clear, artificial one called an intraocular lens (IOL). Both MICS and Phacoemulsification are techniques to achieve this, but they differ in how the lens is removed and replaced.

What is Micro-Incision Cataract Surgery (MICS)?

Micro-Incision Cataract Surgery, often abbreviated as MICS, is exactly what it sounds like—a cataract surgery technique that uses an ultra-small incision. Typically, the incision size is about 1.8 to 2.2 millimetres, making it one of the most minimally invasive approaches available today.

The procedure uses high-tech surgical instruments and advanced fluidics systems to break apart and remove the cataract. The smaller incision not only makes the surgery less disruptive but can also lead to quicker healing and better post-operative outcomes.

One of my patients, a retired school teacher who had a particularly dense cataract, underwent MICS earlier this year. She was understandably nervous about “modern” procedures, but her recovery time was so fast that she was back to enjoying her books within a week—not bad for someone in her late 70s!

What is Phacoemulsification?

Phacoemulsification, or “phaco” for short, has been the gold standard for cataract surgery for decades. This technique involves creating a slightly larger incision than MICS, usually around 2.2 to 3.0 millimetres.

A small ultrasonic probe is inserted through the incision to break up the cataract into tiny pieces using high-frequency sound waves. These pieces are then gently suctioned out.

The process is efficient, with most surgeries lasting only about 20 minutes. After removing the cataract, the surgeon inserts the artificial lens, folded to fit through the small incision. Once in place, the lens unfolds naturally.

Phacoemulsification is highly trusted by surgeons worldwide and offers excellent visual outcomes. However, some newer techniques like MICS are beginning to challenge its dominance in certain scenarios.

Key Differences Between Micro-Incision Cataract Surgery and Phacoemulsification

Now, let’s compare MICS and Phacoemulsification across some critical aspects:

1. Incision Size

MICS: Uses the smallest incision (1.8–2.2 mm). This often means less post-operative irritation and faster wound healing.
Phacoemulsification: Slightly larger incision (2.2–3.0 mm), but still considered “small incision surgery.” Healing is quick but not as rapid as with MICS.

2. Surgical Instruments

MICS: Uses cutting-edge technology with higher precision and specialised instruments to work through the micro-incision.
Phacoemulsification: Relies on tried-and-tested ultrasonic probes for lens removal.

3. Fluid Use

MICS typically consumes less fluid during surgery, reducing stress on the eye’s natural structures, whereas Phacoemulsification might require slightly more.

4. Lens Implantation

Both techniques involve implanting intraocular lenses (IOLs), but the type of lens might vary based on the incision size and the technology used.

5. Recovery Time

MICS: Generally offers quicker recovery. Many patients report reduced instances of post-op inflammation and discomfort.
Phacoemulsification: Recovery speeds are excellent, though slightly longer compared to MICS.

6. Suitability

MICS is ideal for patients who prioritise the least invasive procedure or have eye conditions that could benefit from reduced surgical trauma.
Phaco is more commonly performed, with broad suitability across various cataract types and patient needs.

Advantages and Disadvantages of Each Technique

No surgical technique is one-size-fits-all. Here’s a breakdown of the pros and cons of both methods to give you a clearer picture:

Advantages of MICS:

Smallest possible incision leads to faster healing.
Lower risk of post-op complications like astigmatism.
May reduce intraoperative stress on delicate eye tissues.
Particularly beneficial for younger or healthier patients with straightforward cataracts.

Disadvantages of MICS:

Requires more advanced equipment and training.
May not always be suitable for extremely dense cataracts.
Fewer surgeons are trained in MICS compared to Phacoemulsification.

Advantages of Phacoemulsification:

Proven track record with consistent, excellent results.
Can handle more complex cataract cases, such as very dense lenses.
Widely available and often more affordable.

Disadvantages of Phacoemulsification:

Slightly larger incision compared to MICS.
May cause more stress on the eye during surgery in some cases.

Who Might Benefit from Each Procedure?

When deciding between MICS and Phacoemulsification, your eye surgeon will evaluate several factors, including your age, overall eye health, lifestyle needs, and the complexity of your cataracts. Here’s a general guide:

Micro-Incision Cataract Surgery (MICS): Best suited for patients aiming for the least invasive approach and quickest recovery.
Phacoemulsification: A great choice for patients with more advanced or complicated cataracts, or for those looking for a time-tested and widely available solution.

It’s also worth noting that advancements in technology have made both procedures safer and more effective. Ultimately, your surgeon’s expertise and recommendation will play the most significant role.

My Personal Insight as an Ophthalmologist

Having performed both MICS and Phacoemulsification, I always emphasise that the “better” technique depends entirely on the individual.

I remember one young patient who had untreated congenital cataracts. MICS was perfect in her case because it ensured minimal disruption, allowing her to return to her studies almost immediately.

On the other hand, I’ve helped older patients with dense cataracts who benefitted greatly from Phacoemulsification’s robust approach.

Final Thoughts

Choosing the right cataract surgery technique can feel overwhelming, but remember this: both Micro-Incision Cataract Surgery (MICS) and Phacoemulsification are excellent options, delivering safe and effective results.

While the technical differences matter, the experience of your surgeon and your specific needs play an even more critical role.

If you’re considering cataract surgery, I recommend scheduling a consultation with your ophthalmologist. Ask questions, share your concerns, and work together to choose a procedure that suits your vision goals and health.

Clear vision isn’t just a luxury; it’s the key to living life fully. And with the right approach, achieving it is well within your reach.

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