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Wound architecture, size dictate cataract surgery outcomes

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Visual, refractive and anatomic outcomes in cataract surgery rely heavily on wound size and architecture. Whether a wound is created with a knife or femtosecond laser, its location, configuration and dimensions affect healing and the potential for complications.

Some surgeons prefer posterior limbal or scleral tunnel incisions, while others favor clear corneal incisions. Some choose to close incisions with glue or sealant rather than sutures. Regardless of location and technique, surgeons strive to minimize surgically induced astigmatism, endophthalmitis and hypotony.

John A. Hovanesian

The key to success in cataract surgery, as in any type of surgery, is smaller incisions, according to John A. Hovanesian, MD, FACS, Ocular Surgery News Cataract Surgery Section Editor.

“In cataract incisions, there are a variety of studies that show that less astigmatism results when we have smaller incisions,” Hovanesian said. “Additionally, incisions that are more uniform in shape and size and tend to create a valve-like architecture internally are more likely to self-seal. So, whether using a femtosecond laser, which may offer some repeatability or reproducibility, or a handmade incision, those are really the overarching goals.”