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Microincision cataract surgery has smaller impact on corneal optical quality than small-incision surgery

J Cataract Refract Surg. 2008;34(12):2085-2090.

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Microincision cataract surgery proved more effective than small-incision cataract surgery in minimizing postoperative wavefront aberrations.

The prospective, randomized clinical study included 74 eyes; 36 eyes underwent microincision cataract surgery (MICS) with a 1.5-mm incision, and 38 eyes underwent small-incision cataract surgery (SICS) with a 3-mm incision. Mean patient age was 66.38 years. Anterior corneal topography was measured before surgery, and 3 and 6 months after surgery. Zernike aberrations were calculated for a 6-mm area centered on the pupil.

Postoperatively, two Zernike aberrations, trefoil and tetrafoil, were significantly different from preoperative levels in the MICS group. Trefoil, tetrafoil, oblique astigmatism, secondary oblique astigmatism and vertical tetrafoil changed significantly in the SICS group.

Changes in the SICS group were significantly higher than in the MICS group in total root mean square (P = .007) and higher-order RMS (P = .023) of corneal wavefront aberrations. Higher RMS in the SICS group was attributed to increased oblique astigmatism.

"The results, therefore, indicate that surgically induced astigmatism depends on incision size," the study authors said.

The corneal incision size has a significant role in induction of higher-order aberrations. Smaller incisions induce lesser change in higher-order aberration profile. Although MICS and SICS can produce changes in corneal wavefront aberrations, the magnitude was significantly higher in SICS. The article shows the advantage of MICS over SICS and explains why incision size should be considered in evaluating postoperative induced aberrations after cataract surgery. This study shows that MICS can work as wavefront optimized treatment of refractive errors, which, along with aspheric IOLs in the future, will help in reducing the surgically induced changes in higher- order aberrations.

– Amar Agarwal, MS, FRCS, FRCOphth

OSN Europe/Asia-Pacific Edition Board Member