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G. W. Lyles, K. L. Cohen, I. W. Porter, C. Barnhardt; Clear Corneal Incisions: Architecture and Natural History Described by Anterior Segment Optical Coherence Tomography. Invest. Ophthalmol. Vis. Sci. 2009;50(13):6109.
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© ARVO (1962-2015); The Authors (2016-present)
To describe the postoperative characteristics, architecture, and natural history of clear corneal incisions (CCIs) used in bimanual microincision phacoemulsification cataract surgery (MICS).
Prospective study of 25 eyes of 25 patients with cataract and no other eye disease. Standard preoperative and postoperative examinations were performed. All patients underwent uncomplicated MICS using CCIs by the same attending surgeon. Using a trapezoid blade, 1.2mm x 1.4mm, two limbal paracentesis incisions were made at 10 and 8 or 2 and 4 o’clock, followed by MICS. A 2.75 mm keratome main incision was made to allow injection of a pcIOL into the capsular bag. One 10-0 nylon suture closed this incision and was removed at 1 week. CCIs were analyzed using the Zeiss Visante OCT anterior segment imaging system at 1 day, 1 week, and 1 month postoperatively. For each date the absence or presence of endothelial gaping, detachment of Descemet's membrane, endothelial misalignment, epithelial gaping, epithelial misalignment, and/or loss of coaptation was recorded for each wound. Main chord CCI length and incision angle were measured at 1 day.
Among all wounds, the prevalence at 1 day, 1 week and 1 month of each feature was: endothelial gaping (20%, 16%, 4%); detachment of Descemet's membrane (11%, 3%, 0%); endothelial misalignment (27%, 28%, 26%); epithelial misalignment (4%, 1.3%, 0%); epithelial gaping (2.7%, 0%, 0%); and loss of coaptation (1.3%, 0%, 0%). The most common findings at 1 day were gaping and Descemet’s detachment in the inferior wound (32% and 16% respectively), and endothelial misalignment in the main wound (52%). At 1 week this pattern persisted, endothelial gape (24%) in the inferior wound, Descemet's detachment (8%) in the inferior wound, and endothelial misalingnment (60%) in the main wound. At 1 month endothelial misalignment was the most common finding, main wound 39%, superior wound 22%, and inferior wound 17%.
Endothelial misalignment was the most frequent wound feature at day 1, occurring in 27% of all wounds. The prevalence of endothelial misalignment remained unchanged up to 1 month (26%). In contrast, endothelial gaping was transient and decreased over time from 20% at 1 day to 4% at 1 month. Epithelial gaping, epithelial misalignment, and loss of coaptation were rare and resolved by 1 month. A similar study of only the main CCI at only 1 hour after phaco found a higher incidence of similar features. The use of 21 gauge MICS instruments did not impair wound healing, when compared to the main incision used solely for IOL injection.
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