Effect of phacoemulsification incision size on incision repair and remodeling: Optical coherence tomography assessment

Purpose To characterize the effect of incision size on corneal incision repair and remodeling over 3 months after cataract surgery. Setting Department of Ophthalmology, Auckland District Health Board, Auckland, New Zealand. Design Prospective case series. Methods Eyes having routine cataract surgery were randomized to receive 2.20 mm or 2.85 mm uniplanar clear corneal incisions. Anterior segment optical coherence tomography of incision thickness, length, width, gaping, and angle and specular microscopy of endothelial cell density (ECD), polymegathism, and pleomorphism were completed at baseline and 1, 7, 30, and 90 days postoperatively. Results Each incision group comprised 50 eyes (50 patients). Ninety-nine patients (99%) attended all assessments. The Descemet membrane detachment rate was greater than 50% with 2.20 mm incisions (P = .01). Patients with Descemet membrane detachments had increased endothelial wound gaping, slower visual recovery, and increased corneal thickness at the incision site at all visits (φ = 0.54, P < .01). The 2.20 mm group had greater polymegathism despite no difference in the mean phacoemulsification energy between groups (2.20 mm: 32.3% ± 6.2% [SD]; 2.85 mm: 30.8% ± 6.5%) (P = .02). Ninety days postoperatively, the 2.20 mm group had a lower mean ECD (2195 ± 360 cells/mm2) than the 2.85 mm group (2397 ± 335 cells/mm2) (P = .01). Final visual acuity, gaping, and angles were not significantly different between the groups. Conclusions The 2.20 mm wide corneal incisions were more prone to trauma than 2.85 mm incisions during routine cataract surgery. Corneal incisions with signs of trauma were associated with prolonged visual recovery and slower healing postoperatively.