Clear Corneal Incision Cataract Surgery Research Articles

Case Report of Candida Parapsilosis Keratitis After Cataract Surgery Leading to Corneal Perforation

Purpose:The objective of this study was to report and document a rare case ofCandida parapsilosiskeratitis that occurred following a routine clear corneal incision cataract surgery, ultimately resulting in a perforated corneal ulcer and subsequent need for a penetrating keratoplasty (PK). By presenting this case, the study aims to contribute to the existing literature and raise awareness about the potential risk ofC. parapsilosiskeratitis as a complication of cataract surgery.Methods:In this case report, we describe the presentation and management of a rare fungal infection following routine cataract extraction in an 80-year-old male patient. The patient initially received treatment for suspected endophthalmitis and bacterial keratitis but experienced worsening symptoms, including a small corneal perforation. Upon referral to the clinic, the patient exhibited a fluffy stromal infiltrate near the cataract wound site, an epithelial defect, and a hypopyon. Treatment with compounded topical 1% voriconazole was initiated but did not prevent the progression of the corneal perforation. Attempts to seal the perforation with corneal glue were unsuccessful, leading to the decision to perform a PK. During the surgery, corneal tissue was biopsied and cultured to identify the causative agent.Results:Following PK, the corneal cultures revealed the growth ofC. parapsilosis, confirming the fungal nature of the infection. The patient was then reinitiated on topical voriconazole for a prolonged course of 7 months. Throughout this period, the patient was closely monitored and followed up in the clinic. Fortunately, there were no recurrences of the fungal lesion during this time.Conclusions:No prior cases of a perforated corneal ulcer resulting fromC. parapsilosiskeratitis after routine cataract surgery have been reported in the literature to our knowledge. Our patient experienced postoperative complications characterized by recurrent inflammation, which was treated with potent and frequent topical steroids. This treatment masked the underlying mycotic infection and contributed to corneal perforation. Ultimately, the patient underwent a successful PK procedure to remove the infectious nidus, followed by an extended 7-month course of topical voriconazole. No recurrence of the lesion was observed. Therefore, clinicians should be vigilant for mycotic keratitis, specificallyC. parapsilosis, in patients who display late-onset, persistent inflammation and white plaques at the clear corneal incision site after cataract surgery. The combination of PK and an extended postoperative treatment with topical antifungal agents proves to be an effective strategy for managing corneal perforations caused byC. parapsilosiskeratitis.

Changes in Vector Astigmatism After Superotemporal Versus Temporal Clear Corneal Incision Cataract Surgery.

To investigate vector and refractive astigmatism changes after superotemporal versus temporal clear corneal incision cataract surgery. Patients were diagnosed with age-related cataract with corneal astigmatism < 1.5 diopters (D) and were divided into two groups: superotemporal incision (R group) and temporal incision (L group). Uncorrected visual acuity, manifest refraction, corneal topography, anterior segment optical coherence tomography was performed pre- and six months postoperatively. Total ocular astigmatism, corneal astigmatism, vector of surgically induced corneal astigmatism (SICA), non-corneal ocular residual astigmatism (N-CORA), postoperative intraocular lens decentration and tilt were analyzed. Results: Thirty-eight subjects were included: 21, R group; 17, L group. After surgery, the N-CORA decreased significantly from 1.17±0.72 D to 0.73±0.47 D in all patients (P=0.001), 1.03±0.52 D to 0.70±0.40 D in the R group (P=0.005) and 1.35±0.90 D to 0.78±0.55 D in the L group (P=0.033). Significant differences between t:he R and L groups were found in the postoperative meridian of anterior corneal astigmatism (75.95±52.50 vs 116.79±47.29; P=0.017), total corneal astigmatism (51.65±42.75 vs 95.20±57.32; P=0.011), J45 change vector of SICA in the anterior cornea (-0.10±0.18 vs 0.00±0.11; P=0.048) and total cornea surface (-0.14±0.17 vs 0.03±0.12; P=0.001). Conclusion: The N-CORA decreased significantly after cataract surgery. Superotemporal and temporal incisions caused differences in the meridian components of oblique astigmatism in some patients but did not have a significant effect on the magnitude of corneal astigmatism.

Thrombocytopenia and clear corneal incision cataract surgery.

To investigate complications and outcomes of clear corneal incision cataract surgery in patients with thrombocytopenia. 1 veterans hospital and 2 academic medical centers. Multicenter retrospective chart review. All eyes of thrombocytopenic patients that underwent clear corneal incision cataract surgery with a platelet count of 100 × 103/μL or less measured within 30 days prior to surgery were included. Subject demographics, intraoperative complications, use of pupillary expansion devices, use of local anesthetic injections, and change in corrected distance visual acuity were recorded. 3 sites recorded 40 113 clear corneal incision cataract surgeries, of which 196 eyes (0.49%) of 150 thrombocytopenic patients were recorded. The mean platelet count in the study subjects was 73.0 ± 20.5 × 103/μL. Two cases of intraoperative iris hemorrhage that were readily and controlled occurred in conjunction with pupillary expansion. There were no bleeding complications associated with retrobulbar, peribulbar, or sub-Tenon anesthetic injections. There was a statistically significant improvement (P < .0001) in visual acuity post-operatively. Clear corneal incision cataract surgery with pupillary expansion devices and local anesthetic injections can be safely performed in patients with thrombocytopenia.

The association between toxic anterior segment syndrome and intraocular pressure.

To investigate the association between toxic anterior segment syndrome (TASS) and intraocular pressure (IOP). This is a retrospective, controlled, single-site study. Patients who developed TASS following a clear corneal incision cataract surgery in Rabin Medical Center (Petah Tikva, Israel), between the years 2010-2018, were enrolled. The primary outcome was IOP measured 1, 7 (± 2), and 30 (± 7) days after surgery. The need for ocular hypotensive treatment was the secondary outcome. The study and control groups included 374 and 127 eyes, respectively. The mean IOP in the study and the control groups were 16.3 ± 7.1 and 15.3 ± 3.0 (p = 0.02) at day 1, 13.2 ± 5.0 and 13.7 ± 2.9 (p = 0.18) at day 7, and 13.7 ± 4.1 and 13.5 ± 2.8 (p = 0.65) at day 30. Prevalence of high IOP (> 21mmHg) was significantly higher in the study group solely on the first postoperative day (12.7% and 3.2%, p = 0.002). In the study group, 9%, 3.7%, and 1.6% of the patients required hypotensive medications at day 1, 7, and 30, respectively. Four patients (~ 1%) in the study group developed acute angle closure due to pupillary block, 1-3weeks after surgery and required laser iridotomy and topical treatment. High IOP is considered a concerning characteristic of the late stages of TASS although such association lack supporting evidence. This study did not detect such an association. High IOP was found only in a small group of TASS patients in the early perioperative period.

Intraocular pressure and wound state immediately after long versus short clear corneal incision cataract surgery.

To compare the intraocular pressure (IOP) and wound state immediately after cataract surgery for eyes with a long clear corneal incision (CCI) with those for eyes with a short CCI. Randomized clinical trial. One hundred twenty-eight eyes of 128 patients scheduled for phacoemulsification were randomly assigned to undergo long (≥ 1.75 mm) or short (< 1.75 mm) CCI (2.4-mm wide). IOP was measured using a rebound tonometer preoperatively, at the conclusion of surgery, and at 30 min, 60 min, 120 min, 180 min, and 24 h postoperatively. Wound architecture determined using anterior segment-optical coherence tomography and flare intensity was examined at 60 min postoperatively. The mean incision length was significantly longer in the long CCI group (2.02 ± 0.19 mm) than in the short CCI group (1.50 ± 0.13mm; P < .0001). The mean IOP significantly increased at 120 min and 180 min postoperatively (P ≤ .0005) and returned to the preoperative level within 24 h. The mean IOP did not differ significantly between the long and short CCI groups at any follow-up period. The incidence of IOP lower than 10 mmHg did not differ significantly between the groups. The mean flare intensity was significantly greater in the short CCI group than in the long CCI group (P = .0122). The wound architecture was similar between the groups. IOP and wound architecture were comparable between eyes with a long CCI and eyes with a short CCI in the immediate postoperative periods up to 24 h, suggesting that wound stability is equivalent when the CCI is securely closed with wound hydration.

Wound closure and tissue adhesives in clear corneal incision cataract surgery.

Achieving secure wound closure in clear corneal incision cataract surgery remains highly desired for its role in reducing infection risk and leak-related complications, including hypotony, corneal edema, and lens dislocation. Although classic techniques of stromal hydration or wound suturing represent traditional approaches, the introduction of newer and more effective ocular surface adhesives has increased the options that are available. This review aims to provide an update on the peer-reviewed literature regarding wound closure and the currently available and investigational tissue adhesives used to seal clear corneal incisions in cataract surgery. Stromal hydration and sutured closure of clear corneal incisions remain viable options for wound closure. Wound sealants, particularly polyethylene glycol (PEG)-based hydrogels, have been found to provide watertight wound seal with less foreign-body sensation and surgically induced astigmatism compared with sutures, and less adverse effects and greater ease of use compared with cyanoacrylate and fibrin glues. Stromal hydration, sutured closure, and use of a corneal adhesive are all wound closure options for clear corneal incisions. Of the currently available tissue adhesives, PEG hydrogel sealants have become the most widely accepted, with an improved side-effect and biocompatibility profile.

Changes in shape and astigmatism of total, anterior, and posterior cornea after long versus short clear corneal incision cataract surgery

To compare changes in the shape and astigmatism of the total, anterior, and posterior cornea between eyes with long-length clear corneal incisions (CCIs) and eyes with short-length CCIs in cataract surgery. Hayashi Eye Hospital, Fukuoka, Japan. Prospective case series. Both eyes of patients having phacoemulsification with temporal CCIs were randomized to have a long-length (≥1.75mm) or short-length (<1.75mm) CCI. Corneal astigmatic changes were decomposed to vertical/horizontal (Jackson cross-cylinder, axes at 180 degrees and 90 degrees [J0]) and oblique changes (Jackson cross-cylinder, axes at 45 degrees and 135 degrees [J45]) using power vector analysis. Corneal shape changes were assessed using the average of the difference map on videokeratography 2days and 2, 4, and 8weeks postoperatively. The mean J0 and J45 values of the total cornea in the 120 eyes evaluated were significantly greater in the long CCI group than in the short CCI group at all follow-ups (P≤.0290). The videokeratography showed a wedge-shaped flattening in the total and anterior cornea and a steepening in the posterior cornea around the CCI 2days postoperatively in both groups. This wound-related flattening of the total and anterior cornea rapidly reduced but persisted until 8weeks, whereas the steepening of the posterior cornea disappeared within 4weeks. These changes extended closer to the central cornea in the long CCI group than in the short CCI group. Corneal astigmatic changes were significantly greater after long CCI than after short CCI. The wound-related shape changes occurred immediately postoperatively but rapidly diminished.

Sealed implantation of foldable intraocular lenses.

To evaluate the safety and efficacy of sealed implantation, a simple technique for implanting foldable intraocular lenses (IOLs). This was a retrospective study including consecutive patients who underwent phacoemulsification cataract using the sealed implantation technique. Sealed implantation is a technique in which a single-piece, foldable IOL is implanted without an intraocular ophthalmic viscosurgical device (OVD) or continuous infusion (hydroimplantation) of balanced saline solution (BSS). Forty consecutive patients who underwent clear corneal incision cataract surgery with IOL implantation using this technique were included. A 3-step 2.75-mm incision was performed approximately 0.5 mm anterior to the limbus with a 1.50 to 1.75 mm length as well as a 0.9 mm side port incision. Prior to the insertion of the IOL, the capsular bag and anterior chamber are filled with BSS. Hydroxypropyl methylcellulose 2% is applied external to the main corneal incision. The foldable IOL injector tip is introduced into the main incision in one quick jabbing motion and the IOL injected. The IOL is dialed with a standard irrigating Simcoe cannula. The main outcomes were intraoperative complications and postoperative hypotony. Of 50 charts reviewed, sealed implantation was attempted in 40 (80%), with success in all cases. The injection of the IOL was performed without anterior chamber loss in 92% of the cases (n = 36) and no complications were recorded. There were no events of postoperative hypotony or wound leakage. Sealed implantation is a safe and efficient alternative to hydroimplantation without the need for OVDs in suitable cases.

A comparable study of clinical and optical outcomes after 1.8, 2.0 mm microcoaxial and 3.0 mm coaxial cataract surgery.

To evaluate the clinical and optical outcomes after clear corneal incision cataract surgery (CICS) with three different incision sizes (1.8, 2.0 and 3.0 mm). Eyes of 150 patients with age-related cataract scheduled for coaxial cataract surgery were randomized to three groups: 1.8, 2.0, or 3.0 mm CICS. Intraoperative data and postoperative outcomes including surgically induced astigmatism (SIA), the corneal incision thickness, wavefront aberrations and modulation transfer function (MTF) of cornea were obtained. There were no significant differences among the three groups in demographic characteristics and intraoperative outcome. The 1.8 and 2.0 mm microincisions showed more satisfactory clinical outcomes than the 3.0 mm incision. The 1.8 mm incision showed significantly less SIA than the 2.0 mm incision until postoperative 1mo (P<0.05), but the difference was only 0.14-0.18 D. Combined with less increased incision thickness only at postoperative 1d (P=0.013), the 1.8 mm incision presented better uncorrected distance visual acuity (UCDVA) than the 2.0 mm incision only at 1d postoperatively (P=0.008). For higher-order aberrations and other Zernike coefficients, there were no significant differences between the 1.8 mm group and 2.0 mm group (P>0.05). Converting from 3.0 mm CICS to 1.8 or 2.0 mm CICS result in better clinical and optical outcomes. However, when incision is 1.8 mm, the benefits from further reduction in size compared with 2.0 mm are limited. The necessity to reduce the incision size is to be deliberated.

Analysis of Changes in Anterior, Posterior and Total Corneal Astigmatism after On-Axis Cataract Surgery

Purpose: To assess the changes in anterior, posterior, and total corneal astigmatism after cataract surgery with on-axis clear corneal incision cataract surgery. Methods: This study included 48 eyes (24 eyes with ‘with-the-rule [WTR]’ and 24 eyes with ‘against-the-rule [ATR]’) that underwent phacoemulsification and intraocular lens insertion through on-axis clear corneal incision. The ATR group with vertically steep axis of posterior corneal astigmatism was divided into subgroups 1 and 2 for the opposite axis. Autorefraction, uncorrected and best-corrected visual acuities were measured. Corneal astigmatism (anterior, posterior and total) was measured using Pentacam preoperatively and 1 week, 1 month, and 2 months postoperatively. Results: Multivariate linear regression analysis of preoperative data showed positive correlations among anterior, posterior and total astigmatism. Anterior corneal astigmatism showed a significant decrease in both WTR and ATR groups in all measured points (all p 0.05) and significant decrease in the ATR subgroup 1 (p 0.05). According to correlation analysis based on trend line equations, 1.7 diopters of anterior astigmatism could expect 0.3 diopters of posterior astigmatism and 0.5 diopters of total astigmatism for the WTR group and 0.4 diopters of anterior astigmatism could expect 0.2 diopters of posterior astigmatism and 0.4 diopters of total astigmatism for the ATR group. Conclusions: Considering the majority of cataract patients have vertically steep posterior corneal astigmatism, temporal incision for ATR patients is generally effective. Moreover, for patients with WTR astigmatism of more than 1.7 diopters or ATR astigmatism greater than 0.8 diopters, additional preoperative correction based on posterior astigmatism is needed for more precise prediction of postoperative total corneal astigmatism. J Korean Ophthalmol Soc 2016;57(1):25-35

Hydrogel sealant versus sutures to prevent fluid egress after cataract surgery

To evaluate the effectiveness of a hydrogel sealant versus a suture in preventing fluid egress after wound leakage in cataract surgery. Twenty-four ophthalmic clinical practices in the United States. Prospective randomized parallel-arm controlled multicenter subject-masked study. Healthy patients having uneventful clear corneal incision (CCI) cataract surgery were eligible for the study. Spontaneous and provoked fluid egress from wounds was evaluated at the time of surgery using a calibrated force gauge. Eyes with leakage were randomized to receive a hydrogel sealant (Resure) or a nylon suture at the main incision site. Incision leakage was reevaluated 1, 3, 7, and 28 days postoperatively. Of 500 eyes, 488 had leakage at the time of cataract surgery. The leak was spontaneous in 244 cases (48.8%), and 488 (97.6%) of all incisions leaked with 1.0 ounce or less of applied force. After randomization, 12 (4.1%) of 295 eyes in the sealant group and 60 (34.1%) of 176 eyes in the suture group had wound leakage with provocation (P<.0001). The overall incidence of adverse ocular events was statistically significantly lower in the sealant group than in the suture group (P<.05). In this study, 97.6% of CCIs leaked after cataract surgery. The hydrogel sealant was safe and effective and better than a suture for the intraoperative management of CCIs with leakage as seen on Seidel testing and for the prevention of postoperative fluid egress.

Intraocular Pressure and Wound Status in Eyes Immediately After Scleral Tunnel Incision and Clear Corneal Incision Cataract Surgery

To compare intraocular pressure (IOP) and wound architecture immediately after cataract surgery using a scleral tunnel incision or clear corneal incision. Prospective randomized clinical trial. Bilateral eyes of 64 patients undergoing phacoemulsification were randomized to 2 groups: 2.4 mm scleral tunnel incision or 2.4 mm clear corneal incision. IOP was adjusted upon completion of surgery to between 15 and 30 mm Hg. The wound was hydrated in 87.5% of eyes in the clear corneal incision group. IOP was measured using a rebound tonometer preoperatively; at the conclusion of surgery; and at 5, 10, 15, 30, and 60 minutes postoperatively. The Seidel test and anterior segment optical coherence tomography (AS OCT) were performed at 30 minutes postoperatively. In the scleral tunnel incision group, mean IOP decreased to the preoperative level within 15 minutes postoperatively and did not change significantly for up to 60 minutes. In the clear corneal incision group, IOP decreased to lower than the preoperative IOP at 30 minutes postoperatively. Mean IOP was significantly higher in the scleral tunnel incision group than in the clear corneal incision group throughout the postoperative period (P≤.0339). Hypotony (<10 mm Hg) was observed in 7 eyes (10.9%) that underwent clear corneal incision and in no eyes that underwent scleral tunnel incision (P=.0131). Wound leakage and loss of wound coaptation were not observed in any eyes. IOP was significantly higher immediately after scleral tunnel incision without hydration than after clear corneal incision with hydration, and both incisions closed within 30 minutes postoperatively without leakage based on AS OCT.

Effect of high pressurization versus normal pressurization on changes in intraocular pressure immediately after clear corneal cataract surgery

To compare changes in intraocular pressure (IOP) immediately after clear corneal incision (CCI) cataract surgery between eyes in which IOP was adjusted to a high or normal range at the conclusion of surgery. Hayashi Eye Hospital, Fukuoka, Japan. Comparative case series. Either eye of patients scheduled for phacoemulsification was randomized to 1 of 2 groups as follows: eyes that were to be adjusted to (1) high IOP (22 to 40 mm Hg) or (2) normal IOP (10 to 21 mm Hg). The IOP was measured using a rebound tonometer preoperatively; at the conclusion of surgery; and 15, 30, 60, 120, and 180 minutes and 24 hours postoperatively. The Seidel test and anterior segment optical coherence tomography (AS-OCT) were performed. The mean IOP at the conclusion of surgery was 31.3 mm Hg in the high IOP group and 17.1 mm Hg in the normal IOP group. The IOP decreased to approximately 15 mm Hg by 15 minutes and did not change until 60 minutes in either group. The mean IOP did not differ significantly between groups throughout the observation period (P ≥.0634). Hypotony of 5 mm Hg or less was not detected in any eye. The Seidel test was negative and based on AS-OCT, the wound was closed at 60 minutes in all eyes. After adjusting IOP to a high or normal range, the IOP normalized within 15 minutes postoperatively and was stable for 24 hours. The wound was closed within 60 minutes postoperatively.

Analyses of surgically induced astigmatism and axis deviation in microcoaxial phacoemulsification

To evaluate surgically induced astigmatism (SIA) and axis deviation after coaxial microincision superotemporal clear corneal phacoemulsification incision in eyes with differently located steep axis. This prospective, comparative study included four groups of 45 eyes with age-related cataracts; each group underwent 2.2-mm superotemporal clear corneal incision (CCI) cataract surgery. The four groups of patients were divided by location of the steep axis. Groups were matched according to symmetry of the steep axis for both right and left eyes as follows--0°-45° of steep axis for right eyes, and 136°-180° for left eyes (group 1); 46°-90° for right eyes and 91°-135° for left eyes (group 2); 91°-135° for right eyes and 46°-90° for left eyes (group 3); and 136°-180° for right eyes and 0°-45° for left eyes (group 4). Outcome measures included changes in mean total astigmatism, SIA, and axis deviation. Astigmatism was measured by manual keratometry readings before surgery and week 1, week 4, week 8, and week 12 postoperatively. SIA was calculated by the vector analysis (Holladay-Cravy-Koch method). The magnitude of mean total astigmatism was lowest in group 3 and highest in group 1 at week 12. SIA was 0.39 diopters (D), 0.22 D, 0.17 D, and 0.28 D in group 1, group 2, group 3, and group 4, respectively. The change in astigmatic axis deviation was highest in group 3 (23.6 ± 16.6) (P < 0.05). Axis deviation and SIA were stable after week 4. Planning of CCI on or near the steep axis can help decrease corneal astigmatism.

Late‐onset persistent epithelial ingrowth following uncomplicated clear corneal incision cataract surgery

Late‐onset persistent epithelial ingrowth following uncomplicated clear corneal incision cataract surgery

Late-onset persistent Descemet's membrane detachment following uncomplicated clear corneal incision cataract surgery

We report the case of a 76-year-old man who developed a late-onset Descemet's membrane detachment (DMD) 5 months after uncomplicated cataract surgery. Despite two air tamponade procedures that initially appeared successful, the DMD continued to return. After careful examination it was found that a surgical entry wound may have been scarred open (fish-mouthing), which continually promoted Descemet's membrane to detach. Excision of the abnormal scar led to an almost complete resolution of the DMD. To our knowledge, this is the first report of a pathological (fish-mouthing) entry wound causing a persistent, late DMD. We discuss the reasons why the management of late DMDs requires careful consideration.

Corneal Shape Changes after 2.0-mm or 3.0-mm Clear Corneal versus Scleral Tunnel Incision Cataract Surgery

To compare changes in corneal shape and in regular and irregular corneal astigmatism after 3.0- or 2.0-mm clear corneal incision cataract surgery (CICS) with those occurring after 3.0- or 2.0-mm scleral incision cataract surgery (SICS). Randomized, comparative clinical trials. Ninety patients scheduled for bilateral cataract surgery were randomized to 1 of 2 groups: 3.0- or 2.0-mm CICS in the left eye and 3.0- or 2.0-mm SICS in the right eye or CICS in the right eye and SICS in the left eye. All patients underwent CICS and SICS at the 9-o'clock meridian in fellow eyes. Induced corneal astigmatism was determined using vector analysis, and the averaged changes in corneal shape and irregular astigmatism were examined using videokeratography before surgery and at 2 days and 1, 2, 4, and 8 weeks after surgery. For the 3.0-mm incision, induced astigmatism was significantly greater in the CICS group than in the SICS group (P < or = 0.0329) at 2 weeks and later. The average of difference map on videokeratography in the CICS group showed a marked wound-related flattening and coupled steepening around the flattened area at 2 days after surgery, and these changes persisted for up to 8 weeks: the changes were markedly less in the SICS group. Among the irregular astigmatic components, higher-order irregularity in the CICS group was greater than that in the SICS group (P<0.0001). For the 2.0-mm incision, no significant difference was found between the CICS and SICS groups in induced astigmatism or in irregular astigmatic components. The average of difference map of the CICS group showed a slight wound-related flattening around the incision at 2 days after surgery, but this decreased by 2 weeks; the map of the SICS group showed little change. Changes in corneal astigmatism and shape after 2.0-mm CICS are virtually the same as those after 2.0-mm SICS, whereas those occurring after 3.0-mm CICS are significantly greater than those occurring after 3.0-mm SICS, which suggests that CICS is suitable for microincision cataract surgery. The author(s) have no proprietary or commercial interest in any materials discussed in this article.

Suture-related corneal infections after clear corneal cataract surgery

Three patients at our institution developed corneal infections associated with sutures placed after clear corneal incision cataract surgery. The time to infection was 9 weeks, 22 months, and 33 months. One patient required injection of intravitreal antibiotic agents for presumed endophthalmitis associated with the corneal infection. Two patients were treated with topical fortified antibiotic eyedrops only. Although there was no significant change in visual acuity after resolution of the infection, morbidity from suture-related corneal infections can be significant. Routine suture removal in the early postoperative period may be warranted to prevent such infections.

Induced Astigmatism With 2.2- and 3.0-mm Coaxial Phacoemulsification Incisions

To evaluate the difference between 2.2-mm incision micro-coaxial phacoemulsification and traditional 3.0-mm coaxial phacoemulsification with respect to surgically induced astigmatism after temporally oriented clear corneal incision cataract surgery. This prospective, randomized, intra-patient controlled study comprised 22 patients who underwent clear corneal cataract surgery in both eyes. One eye received 2.2-mm incision micro-coaxial phacoemulsification with intraocular lens (IOL) implantation and the fellow eye received traditional 3.0-mm coaxial incision phacoemulsification with IOL implantation. The 2.2-mm incisions were created with a diamond keratome after a 200-microm groove was constructed in clear cornea at the temporal limbus. The 3.0-mm incisions were created without a pre-cut groove, using a metal keratome. All cases were uncomplicated. Pre- and postoperative keratometric astigmatism at 6 weeks was measured using a hand held Nikon Retinomax K-plus 2 Autorefractor. Three methods were used to analyze the surgically induced astigmatism (SIA) data: 1) algebraic analysis of the magnitude of keratometric astigmatism induced by the surgery, 2) magnitude of SIA by vector analysis, and 3) aggregate analysis of astigmatism using vector analysis. The mean change in the magnitude of keratometric astigmatism was 0.10+/-0.08 diopters (D) with the 2.2-mm micro-coaxial incisions and 0.32+/-0.20 D with the 3.0-mm traditional incisions (P=.0002). Usingvector analysis, the mean magnitude of SIA was 0.35+/-0.21 D with the 2.2-mm incisions and 0.67+/-0.48 D (P=.006) with the 3.0-mm incisions. Surgically induced astigmatism with 2.2-mm micro-coaxial incisions and traditional 3.0-mm clear corneal incisions with intra-patient control resulted in statistically and clinically significant reduction in surgically induced astigmatism with the smaller incision size.

Proper wound construction to prevent short-term ocular hypotony after clear corneal incision cataract surgery

To evaluate the stability of 2.2 mm and 3.0 mm clear corneal cataract incisions with square or nearly square surface architecture. Private practice ambulatory surgical center, Century City, California, USA. A retrospective chart review of 60 patients who had clear corneal cataract extraction between January and September 2006 was conducted. Fifty patients had clear corneal cataract extraction with a square 2.2 mm incision and 10 patients with a nearly square 3.0 mm incision. For the 2.2 mm incision subset, cataract surgery and intraocular lens implantation were accomplished through an unenlarged 2.2 mm clear corneal cataract incision using the Alcon Infiniti unit and an Ultrasleeve for infusion. For the 3.0 mm subset, the Allergan Sovereign unit was used. Intraocular pressure (IOP) was measured intraoperatively at the conclusion of each procedure with a Schiötz or Barraquer tonometer and set between 15 mm Hg and 20 mm Hg. Wound sealing was confirmed by intraoperative Seidel testing in all cases. Intraocular pressure was measured by a Tono-Pen (Medtronic) or Goldmann applanation tonometry between 2 hours and 6 hours after the conclusion of each procedure. The mean postoperative IOP was 19.2 mm Hg +/- 4.9 (SD) (median 18 mm Hg; range 11 to 35 mm Hg) in the group with a 2.2 mm square incision and 16.6 +/- 5.2 mm Hg (median 16.0 mm Hg; range 10 to 25 mm Hg) in the group with a 3.0 mm nearly square clear corneal incision. No patient had an IOP less than 10 mm Hg, and there was no evidence of hypotony or wound leakage by Seidel testing in either group. Clear corneal wounds of square or nearly square surface architecture that are meticulously checked for sealing were stable postoperatively as demonstrated by the absence of hypotony and wound leakage. In the presence of a sealed clear corneal wound, IOP remained reasonably stable relative to the level set at the conclusion of the procedure.