Cataract Removal Technology has undergone rapid advancements and innovations especially in the last two decades. From modest and conventional surgical techniques in the early 80s, now it has become high-tech customized visual enhancement outdoor surgery with excellent visual outcomes. New Microsurgical techniques, foldable advanced aberration free lens implants, gel technology, refractive lenses and futuristic pharmacokinetics have completely changed the cataract scenario in the 21st century. With the advent of new MICS Techniques especially COMICS & BIMICS and foldable lenses, there is more speedy recovery, reduced risk of postoperative astigmatism and return to improved vision in a very short time. Individual eye tailored cataract surgery is now customized to eliminate dependence on glasses for distance, near and intermediate vision.

In this new book The Science and Art: Microincision Cataract Surgery (BIMICS & COMICS) my dear friend Dr Arturo Pérez-Arteaga, in collaboration with Dr Luis Felipe Vejarano-Restrepo, has assembled an impressive collection of chapters divided in four sections to cover all aspects of MICS beautifully. Special feature is their line-up of famous international contributors who have shared their experiences regarding pearls and strategies of MICS techniques.

Section – I of this book is devoted to all important history and background of MICS.

Section – II deals with coaxial microincision cataract surgery, phacodynamics and surgical techniques step by step in a lucid manner.

Section – III includes biaxial microincision cataract surgery innovative techniques, phaco machine dynamics and special techniques like microphakonit by Prof Amar Agarwal and Tri MICS by Dr Jerome Jean-Philippe Bovet.

Section – IV is quite interesting covering newer techniques in COMICS and BIMICS by international masters along with management of complicated cases and futuristic innovations in MICS.

Dr Arturo Pérez-Arteaga and Dr Felipe Vejarano-Restrepo deserve to be congratulated for their stupendous efforts and excellent book on MICS. I hope this comprehensive book on MICS shall provide cutting edge knowledge about COMICS and BIMICS to ophthalmologists worldwide. I am sure this book shall undoubtedly benefit cataract surgeons to sharpen their surgical skills and knowledge. Finally, my kudos to editors, international contributors and publishers M/s Jaypee Highlights Inc. for bringing such a beautiful and well-timed volume on MICS.

If well, the concept talks by itself regarding the reduction of the incision size. The term MICS has been used by some researches for many purposes and to name to various individual techniques, either coaxial or biaxial, during the time of evolution of these new trends. Some authors have utilized this term according to some particular measures of the incision size, while some others have utilized the term to some other kind of approach (e.g. biaxial). Currently, the term MICS is talking about incision size either in the biaxial or in the coaxial approach. Some terms, like Phakonit or Bimanual Cataract Surgery took importance when the techniques were created by the authors, have been reunited with the term MICS and are divided in coaxial or biaxial (COMICS or BIMICS), according to particular approach that the surgeon is using. In the coaxial approach, the irrigation is placed in the same handpiece that is in the aspiration, while in the biaxial approach, the irrigation and the aspiration are in different devices and so performed through different axis.

Interestingly, the most important discoveries of this movement of cataract surgery in the research of the smaller and smaller incisions occurred not in the incision size itself. During the process of decreasing the incision size, the most important developments happened in the field of the performance of phacoemulsification process itself. New trends appeared in the fields like instrumentation, phaco power modulations, phacoemulsification modalities and, in particular, the big improvement in the management of fluidics; since our particular point of view (and as you will see while reading this book, since the point of view of many authors) the key in MICS has been the changes in fluidics performance. While at the beginning of the process, the surgeons created a new way of fluidics management; with the increased number of surgeons performing MICS, the industry understood and new machines with improved fluidics were created. The main advantage of this process is located in the point of less tissue damage and so the decrease in the inflammatory response. The correct performance of MICS leads to the decrease of the postoperative inflammation; the decreased inflammation reduces postoperative complications and improves the visual recovery in time and degree.

If all is well, MICS keeps constant concepts, because these techniques have been developed by many authors worldwide, sometimes differences exist between the physicians in the performance of the surgery. When the surgeon finds that a particular technique is able to give good results in his/her patients, he/she keeps the changes, leading this way to a customized technique. That is why, currently, there are many ways to perform MICS; either coaxial or biaxial, the technique can be very different from one surgeon to another. There are differences in machines, instrumentation, settings, approaches, maneuvers, tools and ideas; even called MICS, two surgeons can perform the surgery in a very different way. The transition is continuous. The transition is something that we experienced and we are still experiencing.

The objective of this book is to demonstrate to the reader by many different ways to perform MICS by some of the most important surgeons in the world, and some applications of this technique to other fields also rather than cataract fm12surgery (e.g. refractive lens exchange). We have tremendous honor to have leaders and pioneers as the contributors of this book in the creation and development of MICS. The ophthalmic community recognizes their work and their knowledge. The reader will be able to notice the differences from one surgeon to another and will be able to decide the particular concepts that might incorporate to his/her surgical practice. The reader will be able to take again some forgotten ideas and mix them with the new ones in performing so a customized and useful technique for the benefit of his/her patients. It is not the objective of this book to find a final technique or a final conclusion in MICS; you will see that what is useful for one author may be useless for the other. In this book, the authors contributed concepts, ideas, knowledge and surgical experience for the goodness of our cataract patients; joining most of the current concepts in MICS.

The idea of working in a project like this was born during the years since we have been performing Instructional Courses at meetings like the American Academy of Ophthalmology (AAO), the American Society of Cataract and Refractive Surgery (ASCRS) and the European Society of Cataract and Refractive Surgery (ESCRS). We have seen through this “window” how MICS was born and how MICS has been evolving during the last decade. We have had the honor that most of the contributors to this have been instructors in our courses. We have been professors but also we have learned from other professors, the audience and from each other. For this reason, we can qualify this project as a description of personal techniques. This book has not a specific sequence; the reader is able to go directly to the information through a particular author or through a particular technique. The concepts are reinforced with pictures and in the case of some authors with surgical videos that demonstrate the written concepts.

This book goes from basic concepts described many years ago until recent applications in MICS, like the very new Femto MICS technique. Definitively, this is not the end in MICS. This book is just describing what is happening now and the basic concepts that gave life to “what is happening now”. New concepts will be in the arena of the cataract surgery during incoming meetings and articles this year, maybe at the same time when this book is being presented. This is the history of the human knowledge, the addition of new concepts to what we have previously learned. But we believe that sometimes, in a particular moment, we have to stop and take some time to obtain a clear view to see where we are standing.

That was our idea…