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Clear corneal, scleral incisions similarly suitable for MICS
Ophthalmol. 2010;117(7):1313-1323.
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A 2-mm clear corneal incision and a 2-mm scleral tunnel incision proved equally appropriate for microincision cataract surgery, a study showed.
However, 3-mm clear corneal incisions yielded more marked and persistent changes in corneal shape than 3-mm scleral tunnel incisions.
"Based on these findings and advantages of the clear corneal incision, including simplicity of performance, the authors suggest that surgeons use the clear corneal incision for cataract surgery when the incision width is 2 mm or less," the study authors said.
The randomized clinical trial included 90 patients assigned to two groups: 3-mm or 2-mm clear corneal incision cataract surgery in the left eye and 3-mm or 2-mm scleral tunnel incision cataract surgery in the right eye, or clear corneal incision cataract surgery in the right eye and scleral tunnel incision cataract surgery in the left eye. Mean patient age was 68.7 years.
Clear corneal incisions and scleral incisions were made at the 9 o'clock meridian; incisions were temporal in the right eye and nasal in the left eye.
Induced and irregular astigmatism as well as changes in corneal shape were assessed preoperatively and at 2 days, 1 week, 2 weeks, 4 weeks and 8 weeks after surgery. Videokeratography was used to measure changes in corneal shape and irregular astigmatism. Vector analysis was used to determine induced corneal astigmatism.
Study results showed that at 2 weeks and later, the 3-mm clear corneal incision group had significantly higher mean induced astigmatism than the 3-mm scleral tunnel incision group (P ≤ .0329). In addition, the 3-mm clear corneal incision group had markedly greater wound-related changes in corneal shape than the scleral tunnel incision group (P ≤ = .0349).
Data showed no appreciable differences in induced astigmatism or irregular astigmatism between the 2-mm clear corneal incision and scleral tunnel incision groups. The 2-mm clear corneal incision group had slightly more wound-related flattening around the incision at 2 days postop; however, the flattening diminished by 2 weeks postop.
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