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Study finds similar endothelial cell loss with MICS, standard cataract surgery
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A prospective study found similar rates of endothelial cell loss between eyes treated with either bimanual microincision or standard small-incision cataract surgery. However, microincision surgery was associated with significantly more corneal swelling at 1 day postop, the study authors said.
Günal Kahraman, MD, and colleagues at the Medical University of Vienna, Austria, compared postoperative trauma between the two surgical techniques in 33 patients undergoing bilateral cataract surgery at a mean age of 71 years. Surgeons randomly assigned one eye of each patient to bimanual microincision cataract surgery (MICS) performed through two 1.4 mm clear corneal incisions.
The second eye underwent small-incision coaxial phacoemulsification through a 3.2 mm temporal clear corneal incision. All eyes received the same foldable hydrophobic acrylic IOL implanted via injector, which required enlarging the temporal incision to 3.2 mm in MICS-treated eyes, according to the study.
Mean effective ultrasound time was significantly higher in the standard cataract surgery group. However, surgery was significantly longer in MICS-treated eyes, and these eyes had significantly more corneal swelling on the first postoperative day, the authors reported.
"Three months after surgery, there was no statistical difference in central pachymetry values," they said.
At 1 day follow-up, central corneal thickness (CCT) averaged 568.69 ± 39.77 µm in the MICS group and 553.93 ± 43.77 µm in the standard surgery group. At 3 months, CCT averaged 550.1 ± 38.83 µm in the MICS group and 547.97 ± 39.87 µm in the standard surgery group, according to the study.
"As both techniques are similar and have important differences only in incision size and total ultrasound energy used, the increased corneal thickness in the MICS group was probably related to the prolonged surgery time and mechanical corneal trauma due to tight corneal tunnels," the authors said.
The MICS group also had a slightly higher rate of endothelial cell loss, which averaged 6.2% compared with 3.1% in the standard surgery group.
"Although the difference did not reach statistical significance ... it is likely that the equivalent difference in a larger study population would be significant," the authors noted.
The study in published in the April issue of the Journal of Cataract and Refractive Surgery.