Conventional Phacoemulsification Research Articles

Standing phacoemulsification: A prospective audit of 20 consecutive cases

To audit the surgical and postoperative complications and the visual outcomes of standing phacoemulsification and compare these with the results of conventional seated phacoemulsification. District general hospital, Sidcup, England. Prospective comparative case series. This prospective audit comprised consecutive patients having standing phacoemulsification; a control group was drawn from all conventional phacoemulsification procedures on the same operating lists. One eye per patient was included. Demographic and surgical data, complications, and preoperative and postoperative visual acuity and intraocular pressure were recorded. Paired and unpaired t tests were used to compare mean values, and the chi-square test with Yates correction or the Fisher exact test was used to compare frequencies. Twenty patients requiring standing phacoemulsification and 89 control patients were enrolled over a 32-month period. The 2 groups were similar in characteristics except the standing group was younger (68.2 years versus 78.0 years) (P<.005) and had a longer axial length (23.8 mm versus 23.1 mm) (P<.05). No patient in the standing group and 6% of patients in the control group had operative complications, although the difference between groups was not statistically significant. The rates of postoperative complications were comparable. Pinhole-corrected distance visual acuity was similar (6/12 or better: 90% in standing group and 94% in control group; 6/6 or better: 55% and 44%, respectively). Best-case analyses were similar between groups (6/12 or better, 100% versus 98%; 6/6 or better, 58% versus 51%). Standing phacoemulsification was as safe as conventional seated surgery when performed by the same experienced surgeon. Visual results were excellent.

Inzisionen für die biaxiale und koaxiale mikroinzisionale Kataraktchirurgie

Microincision cataract surgery (MICS) represents a new level in the development of cataract surgery. Phacoemulsification with intraocular lens (IOL) implantation via incisions of <or=2 mm may be performed by the coaxial approach, such as conventional phacoemulsification but with a smaller diameter of the phaco tip (C-MICS), or by the biaxial approach, with separation of the phaco tip and irrigation (B-MICS). Compared with standard small-incision cataract surgery, the advantages of MICS are less corneal astigmatism and fewer corneal surface irregularities, with favorable implications for visual quality and early rehabilitation. In the effort toward smaller incisions, special interest should be given to wound integrity, especially regarding the risk of endophthalmitis. With limited corneal elastic capacity, irreversible expansion of the incision with tissue laceration may occur. Smaller incisions are superior only if they cause less trauma. This requires an optimized relationship between incision size and manipulation during IOL implantation as well as attention to safety issues. MICS offers a platform for new benchmarks in phacoemulsification.

Progress and Lack of Progress in Glaucoma

Progress and Lack of Progress in Glaucoma

Comparative study of coaxial microincision cataract surgery and standard phacoemulsification

PurposeTo analyse and quantitatively compare the outcomes of microincisional cataract surgery (CCMIC) with those of conventional phacoemulsification, evaluating the induced astigmatism, endothelial cell count, corneal thickness and foveal thickness in the pre- and postoperative period. MethodsProspective and randomised study, including 74 eyes of 37 patients with a mean age of 72.97±7.55 years. All of them underwent conventional phacoemulsification in one eye and CCMIC in the other eye. The evaluated parameters were refractive and topographic astigmatism, endothelial cell count, corneal thickness and foveal thickness, which were measured preoperatively and at 1 day, 1 week, 1 month and 3 months after surgery. ResultsThe variations between pre- and postoperative parameters showed no statistically significant differences between the two surgical procedures (p>0.05). ConclusionsCCMIC is an effective and safe technique that offers an excellent alternative for cataract surgery, with a smaller incision and postoperative outcomes comparable to the standard technique. Prospective studies with more patients and longer follow-ups are needed to establish if there really are statistically significant and clinically relevant differences between both techniques.

The Comparison between Torsional and Conventional Mode Phacoemulsification in Moderate and Hard Cataracts

PurposeTo compare the intraoperative performances and postoperative outcomes of cataract surgery performed with longitudinal phacoemulsification and torsional phacoemulsification in moderate and hard cataracts.MethodsOf 85 patients who had senile cataracts, 102 eyes were operated on using the Infiniti Vision System. Preoperative examinations (slit lamp examination, mean central corneal thickness, and central endothelial cell counts) were performed for each patient. Cataracts were subdivided into moderate and hard, according to the Lens Opacities Classification System III grading of nucleus opalescence (NO). Eyes in each cataract group were randomly assigned to conventional and torsional phaco-mode. Intraoperative parameters, including ultrasound time (UST), cumulative dissipated energy (CDE), and the balanced salt solution plus (BSSP) volume utilized were evaluated. Best corrected visual acuity (BCVA) was checked on postoperative day 30; mean central corneal thickness and central endothelial cell counts were investigated on postoperative days 7 and 30.ResultsPreoperative BCVA and mean grading of NO showed no difference in both groups. Preoperative endothelial cell count and central corneal thickness also showed no significant difference in both groups. In the moderate cataract group, the CDE, UST, and BSSP volume were significantly lower in the torsional mode than the longitudinal mode, but they did not show any difference in the hard cataract group. Torsional group showed less endothelial cell loss and central corneal thickening at postoperative day seven in moderate cataracts but showed no significant differences, as compared with the longitudinal group, by postoperative day 30.ConclusionsTorsional phacoemulsification showed superior efficiency for moderate cataracts, as compared with longitudinal phacoemulsification, in the early postoperative stage.

Comparison of conventional and torsional mode (OZil) phacoemulsification: randomized prospective clinical study

To compare the amount of intraoperative energy used during conventional and torsional phacoemulsification surgery and investigate the changes in corneal endothelial cell density. In this study, a total of 100 eyes in patients with age-related cataract (mean age 68.9 years) were included. Patients were randomly allocated into conventional (group 1) or torsional (OZil, group 2) phacoemulsification. Mean nuclear grade made according to Lens Opacities Classification System II was not different in the 2 groups. Total ultrasound time (USTT), cumulative dissipated energy (CDE), and the percent of total equivalent power in position 3 (%USTEPiP3) were compared between the 2 groups. There were 47 eyes in group 1 and 53 eyes in group 2. Patient age and sex were matched between the 2 groups (p=0.49, p=0.08). Mean USTT was 1.6+/-1.1 minutes (m) in group 1 and 1.5 +/- 0.9 m in group 2 (p=0.55). Average CDE was 29.9+/-16.9 in group 1 and 25.2+/-19.1 in group 2 (p=0.20).Mean %USTEPiP3 was 27.0%+/-8.5% in group 1; however, it was 22.4%+/-6.6% in group 2 (p=0.003). At the first postoperative day, mean corneal edema was graded as 0.25+/-0.5 in group 1 and 0.18 +/- 0.4 in group 2 (p=0.47). At the first postoperative week, it was found to be 0.02+/-0.15 in group 1 and 0.03+/-0.27 in group 2 (p=0.71). ECD loss was 6.7%+/-3.3% in group 1 and 4.2%+/-5.7% in group 2 (p=0.56). No statistically significant difference was found between conventional and torsional phacoemulsification with respect to USTT and CDE. Torsional mode led to a significant reduction in US power in footswitch position 3. Torsional mode also appears to be associated with less loss of ECD.

Optical coherence tomography of macular thickness after biaxial vs coaxial microincision clear corneal cataract surgery

To evaluate macular thickness changes after biaxial microincision versus coaxial small incision cataract surgery using optical coherence tomography (OCT). This prospective, randomized, marked study comprised 70 patients (70 eyes) undergoing biaxial microincision surgery or conventional coaxial phacoemulsification. Patients were evaluated by Stratus OCT preoperatively and 1 day, 4 weeks, and 8 weeks postoperatively. Best-corrected visual acuity (BCVA), phacoemulsification power, and effective phacoemulsification time (EPT) were evaluated. In the biaxial group, median foveal thickness changed from 160 microm preoperatively to 168 microm 8 weeks postoperatively (p=0.018), while median macular volume increased from 2.43 mm3 to 2.57 mm3 (p<0.001). In the coaxial group, median foveal thickness increased from 164 microm preoperatively to 170 microm 8 weeks postoperatively (p=0.082), while median macular volume changed from 2.45 mm3 to 2.55 mm3 (p<0.001). No significant differences in the intraindividual increase of foveal thickness and macular volume were found between groups at 8 weeks. A statistically significant difference between groups was found in median foveal thickness at day 1 postoperatively (p=0.027). No significant differences between groups in median macular volume were found at day 1 or at 4 and 8 weeks postoperatively. Median phacoemulsification power was 7.1% and EPT 2.4 seconds in the biaxial group versus 10.6% and 3.2 seconds in the coaxial group (p<0.001 and p=0.078). No clinically relevant differences in foveal thickness or macular volume were observed after biaxial microincision and coaxial small incision clear corneal cataract surgery. The blood-retinal barrier did not seem to be influenced by either procedure.

Comparison of central corneal edema and visual recovery between liquefaction and conventional phacoemulsification in soft cataracts

PURPOSE: The aim of the present study is to assess central corneal edema and visual recovery after cataract surgery performed according to two technologies: conventional ultrasonic and liquefaction (Aqualase®). METHODS:This is a prospective contralateral study in wich 20 patients with comparable preoperative conditions were submitted to cataract surgery were evaluated. Preoperative assessment involved complete ophthalmological examination and the study included patients with bilateral cataracts up to grade 2, according to the Lens Opacity Classification System II. The same cristaline fracture technique was used in all cases, and surgical procedures were performed by the same experienced surgeon, using two technologies: liquefaction or conventional phacoemulsification. Postoperative central corneal edema was measured by corneal optical pachymetry (Orbscan II®) on the 1st, 3rd, 7th and 10th postoperative days. RESULTS:None of the 20 patients submitted to surgery was lost during the postoperative follow-up or excluded from the analysis. On the first postoperative, the visual acuity average was 0.031 logMAR in the Aqualase® group and 0.043 logMAR in the conventional surgery group. No statistical difference was detected in the assessment of visual acuity throughout the postoperative period. Central corneal pachymetry varied from 543.93 + 34.69 preoperatively to 545.08 ± 25.67 on the last day of follow-up in the Aqualase® group, and from 543.13 + 30.62 to 536.08 + 34.89 in the conventional technique group, without statistical significance. CONCLUSION:This study suggests that both techniques are equally effective for surgery on lenses with grade I or II cataract, and that they provide similar results in terms of visual recovery and central corneal edema.

Comparison Between Bimanual Microincisional Cataract Surgery and Conventional Coaxial Phacoemulsification

Purpose: To evaluate corneal endothelial cell changes after conventional coaxial phacoemulsification and bimanual microincision cataract surgery (MICS). Methods: Forty patients were divided into 2 groups, coaxial phacoemulsification (Group 1, n=20), and MICS (Group 2, n=20). To evaluate corneal endothelial cell changes after coaxial phacoemulsification and bimanual MICS, intraoperative phacoemulsification power and volume of intraoperative irrigation solution (balanced salt solution, BSS, Alcon, U.S.A) were measured. Central corneal thickness and endothelial cell count were also evaluated, preoperatively and at 1 week, and 2 months postoperatively. Results: Between the 2 groups, there was no statistically significant difference in intraoperative phacoemulsification power and volume of intraoperative irrigation solution (balanced salt solution, BSS, Alcon, U.S.A.) (p＞0.05). In addition, there was no statistically significant difference between the 2 groups in endothelial cell count and central corneal thickness (p＞0.05). Conclusions: When comparing bimanual MICS and conventional coaxial phacoemulsification, bimanual MICS appears to have similar endothelial cell changes. In conclusion, MICS has the same safety as compared to coaxial phacoemulsification.

Comparison of Clinical Results Between OZil® Mode and Hyperpulse Mode in Phacoemulsification

Purpose: To compare the intraoperative and short term postoperative outcomes of cataract surgery performed with custom pulse mode of OZil and hyperpulse mode of conventional phacoemulsification Methods: The patients underwent cataract surgery using the OZil custom pulse mode phacoemulsification (Group 1, n=30) or the conventional phaco Hyperpulse mode one (Group 2, n=36) of Infiniti Vision System. Mean ultrasound time, CDE (Cumulated dissipated energy) and total BSS volume were measured during operation. Best corrected visual acuity, central corneal thickness and endothelial cell counts were checked on 1 day, 1 momth, 2 months after surgery. Results: CDE was decreased significantly in group 1 (p0.05). At 2 months, the endothelial thickness was 552.9427.95 in group 1, and 568.00 in group 2 and the endothelial cell counts was 2683.0235.6 cell/ and 2694.2407.9 cell/, respectatively. There were no significant differences in two groups. Conclusions: The OZil custom pulse mode phacoemulsification is an effective procedure in cataract surgery as much as the conventional hyperpulse mode phacoemulsification.

Lensectomy Using a Bimanual Microincision Cataract Surgery Technique During Pars Plana Vitrectomy

Lens extraction during vitrectomy is sometimes necessary to obtain an adequate view of the retina. Currently, phacoemulsification through a clear corneal incision with implantation of a foldable intraocular lens has become the preferred technique for cataract extraction during pars plana vitrectomy. The authors described the technique of lensectomy using a bimanual microincisional cataract surgery technique during pars plana vitrectomy and insertion of the intraocular lens at the end of surgery, which has several advantages over conventional coaxial phacoemulsification procedures.

Comparison of corneal endothelial cell loss during phacoemulsification using continuous anterior chamber infusion versus those using ophthalmic viscosurgical device: Randomized controlled trial

AimWe conducted this study to evaluate and compare corneal endothelial cell loss between phacoemulsification with continuous anterior chamber infusion using anterior chamber maintainer (ACM) and phacoemulsification using ophthalmic viscosurgical device (OVD).Materials and MethodsThis was a prospective, randomized controlled trial. Fifty eyes of 47 patients of senile cataract undergoing phacoemulsification were included. Patients were randomly allocated into two groups of 25 eyes each. Cataract surgery was performed by phacoemulsification with anterior chamber (AC) continuous infusion with balanced salt solution (BSS) plus and ACM without OVD in Group A, and in Group B, phacoemulsification was performed using OVD with BSS plus. Corneal endothelial cell count and pachymetry were performed preoperatively and postoperatively on day 1, day 7, and day 30.ResultsThe mean increase in pachymetry was 4.86%, 2.94%, and 1.94%, (Group A) and 5.95%, 3.94%, and 0.51%, (Group B) on first, seventh, and 30th postoperative day respectively. The difference between the percentage increase in pachymetry between the two groups was not significant at day 1 (P = 0.441), day 7 (P = 0.298), and day 30 (P = 0.174) postoperatively. The density of endothelial cells decreased postoperatively (day 30) by 7.38% (Group A) and 7.47% (Group B) without any significant statistical difference (P = 0.983) between two groups.ConclusionUse of ACM for continuous AC infusion and omission of OVD during phacoemulsification did not cause significant difference in corneal swelling or endothelial cell loss in the immediate postoperative period up to one month.

Experimental study on the self-made cooling system for tip of phacoemulsification in decreasing the thermal insury of incision

目的 评价自行设计的超乳针头冷却系统在防止切口热灼伤的作用.方法 采用自制超声乳化针头冷却系统对超乳针头进行术中强制降温,比较在对兔眼行连续能量超声乳化术中,传统超乳组(A组)与制冷超乳组(B组)在不同超乳时间手术切口温度情况及术后切口处角膜水肿情况.结果 1、B组在各乳化时间点上的切口温度测定值均低于A组的相应值,组间差异(P＜0.01);2、术后(乳化时间＞90s),B组切口处角膜水肿混浊程度和数量明显低于A组,组间差异(P＜0.05).结论 在超声乳化术连续能量模式下,自制超乳针头冷却系统能有效减少和防止术中切口热损伤的发生。

Anterior chamber depth and change in axial intraocular lens position after cataract surgery with primary posterior capsulorhexis and posterior optic buttonholing

To compare axial position changes of the intraocular lens (IOL) by measuring anterior chamber depth (ACD) after small-incision cataract surgery with primary posterior continuous curvilinear capsulorhexis (PPCCC) and posterior optic buttonholing (POBH) of the IOL and after conventional cataract surgery with phacoemulsification and in-the-bag IOL implantation. Department of Ophthalmology, Medical University of Vienna, Austria. This prospective comparative study comprised 23 patients (46 eyes) with age-related cataract who had bilateral cataract surgery and implantation of an acrylic IOL (YA-60BB, Hoya). In randomized order, cataract surgery with PPCCC and POBH of the IOL was performed in 1 eye of each patient. In the fellow eyes, conventional phacoemulsification cataract surgery with in-the-bag IOL implantation was performed. The ACD was measured 1 to 2, 6, and 24 hours as well as 7 and 30 days postoperatively using high-resolution partial coherence laser interferometry. A baseline measurement was taken preoperatively in all patients. Ten patients completed 10 to 12 months of follow-up. Postoperatively, the axial IOL position was stable in eyes with PPCCC-POBH (P>.05). In contrast, a significant axial shift of the IOL in the anterior direction was observed in control eyes with in-the-bag IOL implantation (P<.001). The resulting refractive shift was significantly higher in control eyes than in eyes with PPCCC-POBH (P<.001). Combined PPCCC and POBH for cataract surgery significantly reduced postoperative anterior movement of the IOL.

The Laparotomy Incision: a Technique to Facilitate Capsulorhexis in Microincision Cataract Surgery

Microincision cataract surgery is a new technique in the development of cataract surgery and is not without difficulties. Creation of the continuous curvilinear capsulorhexis as performed in conventional coaxial phacoemulsification surgery does not apply as readily. The authors describe a method for initiating the continuous curvilinear capsulorhexis (the laparotomy incision) using only an inexpensive 25-gauge bent needle cystototome. The technique involves a long linear incision in the anterior capsule down the belly of the lens as a means of initiating the capsulorhexis. Advantages of the technique include the creation of a large capsular flap, which allows easier completion of the continuous curvilinear capsulorhexis through a smaller range of movement, avoiding "oar locking" in the small incision and creation of striae in the cornea. It also allows better maintenance of anterior chamber depth, minimizing risk of radial tears.

The Effectiveness and Safety of the Phaco Prechopper Technique Before Lens Phacoemulsification in Cataract Surgery

Purpose: To compare the effectiveness and safety of the phaco prechopper technique dividing lenses into 2 or 4 pieces before phacoemulsification with the effectiveness and safety of conventional phacoemulsification during cataract surgery. Methods: This study included 360 eyes, which were divided into 4 groups according to nuclear opacity each group was subdivided into 3 groups according to the lens extraction technique (control, dividing the lens into two pieces using a phaco prechopper, and dividing it into four pieces) (Table 1). The following parameters were compared between the groups that had the same degree of nuclear opacity: changes in the endothelial cell count and hexagonality 2 months postoperatively, phaco time as well as the total phaco energy used for the operation, and the complication rates. Results: There were no intra- and post-operative complications in any group. The endothelial cell loss rate was significantly less in nuclear opacity groups 2 and 3 with the prechopper technique than in the control group. Hexagonality was significantly higher in the nuclear opacity group 3 with the prechopper technique than in the control 2 months after the operation. Phaco time was significantly less in the nuclear opacity groups 2 and 3 with the prechopper technique than in the control. Total phaco energy was significantly less in the nuclear opacity groups 2, 3, and 4 with the prechopper technique than in the control. Conclusions: Phacoemulsification using the prechopper technique is safe, resulting in significantly less endothelial cell damage, and requires less phaco time and less total phaco energy compared to those of the conventional phacoemulsification technique.

Mirror telescopic intraocular lens for age-related macular degeneration: Design and preliminary clinical results of the Lipshitz macular implant

To conduct a pilot study evaluating the visual and surgical outcomes of an intraocular mirror telescopic intraocular lens, the Lipshitz macular implant (LMI) (Optolight Vision Technology), for age-related macular degeneration (ARMD) and other macular pathology. Dr. Agarwal's Eye Hospital and Eye Research Centre, Chennai, India. The LMI was implanted in patients with bilateral macular pathology and visual acuity worse than 20/200 in whom vision improved with a x2.5 external telescope preoperatively. The LMI was implanted after conventional phacoemulsification or microphakonit. The minimum follow-up was 6 months. Six eyes of 6 patients had surgery in the worse eye. Four eyes had ARMD, and 1 eye each had myopic macular degeneration or macular dystrophy. There were no intraoperative complications. The mean gain in distance acuity was 3.66 lines +/- 1.88 (SD), and the mean increase in the Early Treatment Diabetic Retinopathy Study score for near acuity was 50.83 +/- 9.15 logMAR. The best corrected distance acuity and near acuity improved significantly (both P = .014). The mean change in endothelial count was -5.79% +/- -4.07%. The mean postoperative corneal endothelial-LMI distance was 3.15 +/- 0.31 mm. A good central fundus view was possible around the mirrors in all eyes. Fundus fluorescein angiography showed good visibility of the retina up to the midperiphery. The mean score on a quality-of-life questionnaire was 11.16 +/- 1.72 (SD) preoperatively and 4.50 +/- 0.83 postoperatively, a statistically significant improvement (P = .014). The LMI may be an effective solution for optical rehabilitation of patients with ARMD or other macular pathology by increasing the central image on the retina while preserving peripheral vision. The surgery and visual recovery were quick, and the improvement in quality of life was significant.

Site of Incision and Corneal Astigmatism in Conventional SICS versus Phacoemulsification

High astigmatism is an important cause of poor uncorrected visual acuity after cataract surgery. The aim of the study is to compare the astigmatism induced by a superior and temporal incision in manual SICS, and to compare the astigmatism induced by clear corneal incision versus scleral tunnel in phacoemulsification surgery. A total of 64 eyes of 64 patients (34 male/30 female) with a mean age of 62.10 years (range 45-82 years) were included in the study. The cases were randomly divided into two groups. One group (Group I) had undergone manual SICS and the other group (Group II) had undergone phacoemulsification. The manual SICS group patients were randomly allotted into two subgroups depending on the site of incision. Group Ia received superior incision while group Ib received temporal incision. The Phacoemulsification group (Group II) patients were randomly divided into two groups depending on the location of the incision. Group IIa received clear corneal incision and group IIb received scleral pocket incision. Informed consent was obtained from all the patients undergoing study. Surgically induced astigmatism is calculated by the substraction method. We found significantly against the rule shift in astigmatism in the phacoemulsification group and the manual SICS superior incision group. The manual SICS group with temporal incision (Ib) had with-the-rule shift in astigmatism. At 90 days, conventional SICS superior incisions gave 1.92 +/- 0.53 D against the rule and temporal incisions 1.57 +/- 0.24 D with the rule astigmatism. Phacoemulsification clear corneal incisions showed 1.08 +/- 0.36 D and scleral pocket 1.23 +/- 0.71 D astigmatism.

ThinOptX vs AcrySof: Comparison of visual and Refractive Results, Contrast Sensitivity, and the Incidence of Posterior Capsule Opacification

To evaluate the visual and refractive results, the changes in contrast sensitivity, and the incidence of posterior capsule opacification (PCO) after the implantation of UltraChoice 1.0 ThinOp-tX (ThinOptX Inc.) intraocular lens (IOL) and conventional acrylic foldable IOL (AcrySof MA30AC). Twenty-five patients were randomized into two groups prospectively. In Group 1, microincisional phacoemulsification and the ThinOptX IOL implantation were applied in one eye, and in Group 2, conventional phacoemulsification and the AcrySof IOL implantation were applied in the fellow eye. Uncorrected visual acuity (UCVA) and best-corrected visual acuity (BCVA), surgically induced astigmatism (SIA), contrast sensitivity, and the incidence of PCO were observed in the two groups and comparisons were made. Mean follow-up period was 12.8+/-1.5 months (range 11 to 14 months). In the last follow-up examination, UCVA and BCVA were significantly lower and the PCO scores were significantly higher in Group 1 (p<0.05). Although SIA was lower in Group 1, the difference was not statistically significant. Contrast sensitivity in higher spatial frequencies was significantly lower in Group 1 in the 6th month and 12th month visits. Capsular contraction was seen in 3 eyes (12%) in Group 1 whereas there was no capsular contraction or phimosis in Group 2. Long-term evaluation of the ThinOptX IOL concludes with an increased rate of PCO, a diminished resistance to the capsular contraction vs the AcrySof IOL, and a decrease in visual performance. The poor after cataract performance of this rollable lens shows that microphacoemulsification and ThinOptX IOL implantation is not as effective as conventional hacoemulsification and AcrySof IOL implantation in the long term.

Intraindividual comparison of surgical trauma after bimanual microincision and conventional small-incision coaxial phacoemulsification

To compare the surgical trauma after microincision phacoemulsification and small-incision coaxial phacoemulsification after implantation of conventional, foldable, hydrophobic acrylic intraocular lenses (IOLs). Department of Ophthalmology, Medical University of Vienna, Vienna, Austria. A prospective investigator-masked case series comprised patients with bilateral cataract who had cataract surgery on the same day. Thirty-three patients (66 eyes) were randomized. Microincision cataract surgery (MICS) was performed through 2, 1.4 mm clear corneal incisions (CCIs) using bimanual sleeveless phacoemulsification (cool phaco) in 1 eye. Small-incision cataract surgery (SICS) was performed on the other eye through a 3.2 mm CCI. In all cases, an AcrySof SA60AT IOL was inserted, in the MICS group after the CCI was enlarged. Laser flare photometry, specular microscopy, corneal endothelial cell density, and pachymetry were evaluated preoperatively and postoperatively. Intraindividual comparison and statistical analyses were performed. There were no relevant clinical differences or perioperative complications in either group. There were no statistically significant differences between preoperative and postoperative anterior chamber flare or endothelial cell loss. On the first postoperative day, the MICS group had statistically significantly increased corneal swelling (P = .008). Postoperatively, the mean endothelial cell density loss was higher in the MICS group (6.2%) than in the SICS group (3.10%); however, the difference between groups was not significant (P = .08) Microincision cataract surgery was a safe and reproducible technique. The postoperative results in the MICS group were comparable to those in the SICS group.