Small cataract surgery incisions prone to corneal trauma

Investigators characterized the effect of cataract surgery incision size on corneal repair and remodeling.

Study design

This prospective case series included 100 patients randomized to an incision size of 2.20 mm or 2.85 mm during routine cataract surgery by a single surgeon. Ninety-eight patients completed 90 days of postoperative follow-up. Anterior segment OCT was used to evaluate incision thickness, length, width, gaping and angle. Specular microscopy was used to assess endothelial cell density (ECD), polymegathism and pleomorphism.

Outcomes

On day 1 postop, the 2.20-mm incision group showed a greater rate of Descemet membrane detachment compared with the 2.85-mm group (62% vs. 40%; P=0.01). There were no Descemet detachments present in either group at 3 months.

At 3 months postop, the 2.20-mm group had greater polymegathism (32.3% vs. 30.8%; P=0.02) and a higher rate of ECD loss (2195 vs. 2397 cells/mm²; P=0.01) than the 2.85-mm group.

Outcomes

This study was limited by a short follow-up period.

Clinical significance

The findings in this study suggests that smaller incision sites may be more prone to trauma, including microtears and stretching as well as potentially faster fluidic currents and turbulence in the anterior chamber. The long-term effects of these findings are unknown. However, patients with Fuchs endothelial dystrophy or other endothelial abnormalities might benefit from a 2.85-mm incision to help minimize endothelial damage.