For decades, ultrasound phacoemulsification has been the mainstay of cataract surgery. With the announcement in September 2024 of the broad US distribution of the MICOR 700, which uses non-ultrasonic lens extraction technology, Zeiss has introduced a potentially revolutionary option for cataract surgery.

The device represents a “real paradigm shift in how we remove cataracts,” says Sonia H. Yoo, MD, professor of ophthalmology, cataract, cornea and refractive surgery, Bascom Palmer Eye Institute in Miami.

Mechanical Movement 

Unlike phaco devices, the MICOR 700 is a handheld mechanical system, with the pump located in the handpiece. It consists of a power plug, transformer and handheld device, according to Frank Seitzinger, head of business sector surgery anterior segment at Zeiss. The handpiece contains the motor and a disposable tip.

Compared to phaco, notes Zeiss, the MICOR 700 uses a finger throttle to control aspiration vacuum, and cavitation-free oscillation with non-ultrasonic lens extraction sonic energy. The MICOR 700 employs a three-piston displacement pump. With this pump, Zeiss states the MICOR 700 method of disrupting tissue creates a gentler experience by using a quick, strong vacuum synchronized with longitudinal oscillation that operates at 40 Hz, free of cavitation and heat, compared to the 30,000-40,000 Hz with cavitation seen with phaco. The device uses “very minute mechanical movements that destroy the cataract and then extract it,” says Mr. Seitzinger.

In addition, the MICOR 700 features a novel blunt tip design with rounded edges, designed to minimize the risk of tissue damage, according to Zeiss.

Minimizing Thermal Damage 

The Zeiss non-ultrasonic lens extraction procedure is designed to deliver less thermal energy than phaco and to minimize the risk of thermal damage to ocular tissue, says Zeiss. Asymmetric oscillation of the cutter tube allows cavitation-free lens removal.

“MICOR strikes me as the first landmark change in cataract surgery since Charles Kelman first introduced us to phacoemulsification in 1964,” says Neel R. Desai, MD, of the Eye Institute of West Florida in Tampa, FL. “For the last 60 years, we’ve only managed to refine the manner in which we ultimately deliver ultrasound energy. MICOR uniquely doesn’t use ultrasound or cavitation at all, rather relying on high vacuum and sub-ultrasonic energy all generated at our fingertips.”

While traditional peristaltic and Venturi-based platforms can also generate high vacuum, this often comes at the cost of higher risk of post-occlusion surge as vacuum builds within compliant tubing, according to Dr. Desai. “MICOR generates vacuum from pistons built into, and controlled with, the handpiece itself very proximate to the eye. Hence, we can more safely access higher vacuum levels without any surge transmitted through meters of tubing,” he explains.

What’s more, according to Dr. Desai, is that because fluidics are controlled sheer millimeters from the eye, less fluid infusion is required to maintain stability. “Less fluid throughput in an eye directly translates to less stress on endothelial cells, less corneal edema, and clearer corneas at the end of a case. This means we can talk about ‘post-op one-minute wow factor’ not just day one or week one.”

“There’s a lot more fluid that runs through the eye using the conventional ultrasound phacoemulsification,” says Dr. Yoo. With the MICOR 700, Dr. Yoo estimates that she averages less than 30 ml of saline to finish a case, vs between 50 and 200 mL with phaco. Dr. Desai reports that after his initial 10 cases with MICOR, his next 200 cases averaged a total of 18 cc BSS utilization per case and 20-30 seconds for nucleus removal, rivaling traditional phaco.

Saving Time and Cost

From a practice perspective, the MICOR 700 is likely to save a surgeon space, time and cost. As a handheld device, “it makes for a much smaller footprint in the operating room because there’s no machine, there’s no foot pedal. The entire device is controlled with a lever at your fingertips,” notes Dr. Yoo.

The device can save significantly in set up time. “MICOR is quite literally 30 seconds to plug and play vs several minutes of priming and set up for traditional phaco,” says Dr. Desai  “Eliminating this dead time produces significant economy of scale for a busy ASC like ours.”

With the use of disposable tips and a single motor drive, the MICOR 700 may well be more cost effective per case than phaco, notes Dr. Yoo.

Complement to Phaco

Both Dr. Desai and Dr. Yoo use the MICOR 700 in specific cases while continuing to use phaco for other patients. “They’re complementary devices,” says Dr. Desai.

Dr. Desai will use the MICOR 700 for patients with compromised corneas, Fuchs dystrophy and other kinds of endothelial dystrophies. He also prefers it with patients who have softer cataracts, refractive lens exchanges or when patients have elected for a premium IOL, where he wants their visual recovery to be fastest. In addition, he sees MICOR as essential to MIGS—where visualization of the angle through a clear cornea is crucial. 

For Dr. Yoo, the MICOR 700 is her go-to lens removal device for one to two plus nuclear sclerotic contacts. For a denser cataract, she’ll choose phaco, as she feels that the MICOR 700 is not as efficient for removing dense lenses compared to phaco. “MICOR couples nicely with MiLoop, so I still find it quite applicable to dense cataracts in the presence of a compromised cornea, especially for surgeons who are already facile with chopping techniques for nucleus disassembly,” adds Dr. Desai.

Zeiss positions the MICOR 700 for premium treatment, says Mr. Seitzinger. Reimbursement works the same as for phaco, Zeiss notes, using the same CPT code.

Anecdotally, Dr. Desai feels that, compared to phaco, for patients where he’s used the MICOR 700, “the corneas typically are a lot clearer, and their post-op day one vision is better. MICOR is helping produce corneas as clear at the end of the case as at the beginning, which makes for happy patients and happy surgeons alike.” OM

Disclosures: Dr. Desai is a consultant and speaker for Zeiss. Dr. Yoo is a consultant for Carl Zeiss Meditec.