I recently had the honor and privilege to moderate a live surgery program at the winter Belgian Society of Cataract and Refractive Surgery (BSCRS) meeting in Brussels, Belgium. This extraordinary session featuring 11 cases in 4 hours demonstrated a variety of methods and technologies of microincision cataract surgery (MICS). The session was highly educational, and I felt that our readership would benefit if the live surgery participants put their personal views and preferences on MICS into writing. The participants kindly agreed to our invitation, and within these pages are their thoughts in the form of a focus on MICS.

As a recent adopter of MICS, I can fully understand the excitement and thrill experienced by the advocates of the technique.

So does moving from 2.7 to 1.8 mm really make a difference? In my personal experience, it does. Apart from the fact that a 2.7-mm incision now looks medieval by comparison, whether using microcoaxial or bimanual, the 1.8-mm incision is—as Jorge L. AliÛ, MD, PhD, of Spain, indicates—less aggressive. There is no question that a surgeon experiences more control with a smaller incision; however, there is a higher demand for phaco technology that emphasizes good fluidics control and harmony among all parameters, including the needle gauge, bottle height, flow rates, ultrasound power, and duty cycle. Overall ultrasound times have been dramatically reduced to just a few seconds, and chamber stability and control are now fabulous.

As for the learning curve, it was almost nonexistent in my experience, and the transition to using microcoaxial was uneventful. I have performed MICS with the Stellaris (Bausch & Lomb, Rochester, New York). This machine is a remarkable leap forward in terms of technology.

Now that we can accomplish phacoemulsification through smaller incisions, we need implants that can be reliably and safely inserted through these tiny incisions. There are some already available, and more IOLs and instruments are being developed to accomplish small-incision implantation. I typically use the Acri.Tec Acri.LISA (Carl Zeiss Meditec AG, Jena, Germany) multifocal IOL through a 1.8-mm incision. But I do have to take care not to dissect Descemet's membrane, revisiting an old problem reported with early foldable lens implants. A small change in the insertion cartridge should be able to solve this problem, again demonstrating the need for change in instrumentation to accommodate this new technique.

We hope you enjoy this focus, and I would like to thank the surgeons for their valuable contribution, including Robert J. Van Hoorenbeck, MD, President of the Belgian Society of Cataract and Refractive Surgery, and Jérôme C. Vryghem, MD, who organized the BSCRS live surgery session and kindly helped coordinate this article series.

Sheraz M. Daya, MD, FACP, FACS, is the Director and Consultant, Corneoplastic Unit and Eyebank, at the Centre for Sight, Queen Victoria Hospital, East Grinstead, UK. Dr. Daya states that he is a consultant to Bausch & Lomb and has received travel grants in the last year. He is the Co-Chief Medical Editor of CRST Europe. He may be reached at sdaya@centreforsight.com.