Small incision may not be optimal in wound integrity

The incision sizes created during microincision phacoemulsification have continued to decrease in size from 2.4 to 1.8 mm and even smaller. However, with these wounds intraocular manipulations can be problematic, said Dr. Vasavada, Iladevi Cataract and IOL Research Centre, Raghudeep Eye Clinic, Ahmedabad, India. In addition, the phaco energy and stretching of the wound with IOL implantation might lead to wound distortion that ultimately might affect the integrity of the wound.

She previously reported that in a comparison of bimanual, standard coaxial, and 2.3-mm microcoaxial incisions, bimanual incisions allowed greater ingress of ocular surface fluid into the anterior chamber.

The 1.8-mm clear corneal incisions were created during phaco using one phaco platform (Stellaris, Bausch + Lomb), and the 2.2-mm clear corneal incisions were created during phaco using another phaco platform (Infiniti Vision System, Alcon Laboratories).

When phacoemulsification was completed, the incisions underwent histomorphologic evaluation to study the gross wound integrity, collagen immunofluorescence to study the lamellar pattern of the collagen, and analysis of the collagen denaturation.

The epithelium was debrided in the 1.8-mm and the 2.2-mm groups.

"The 2.2-mm group showed a higher incidence of slight Descemet's [membrane] detachment at the incision," Dr. Vasavada said. "However, the stroma in the 1.8-mm group had a vertical split with some hydration in the phacoemulsification-only group. After IOL implantation, the stromal disorganization and hydration increased significantly in the 1.8-mm group; however, in the 2.2-mm group the stroma is uniform and regular."