Coaxial Microincision Cataract Surgery Research Articles

Impact of different clear corneal incision sizes on anterior corneal aberration for cataract surgery.

To investigate the impact of different sizes of steep meridian clear corneal incisions for phacoemul sification on anterior corneal higher-order aberrations. Medical records of patients who underwent 2.2-mm coaxial micro-incision cataract surgery or 2.75-mm coaxial small-incision cataract surgery were retrospectively reviewed. Only patients with preexisting anterior corneal astigmatism <2.00 diopters (D) and ≥0.50 D who underwent a steep meridian clear corneal incision were included. Primary outcomes were 3rd- to 6th-order anterior corneal higher-order aberrations with an 8-mm pupil. Anterior corneal astigmatism and effective phaco time were evaluated as secondary outcomes. Preoperative and 3-month postoperative outcomes were evaluated. Anterior corneal astigmatism significantly decreased after both procedures; however, there was no significant difference found in surgically induced anterior corneal astigmatism between the two procedures (p=0.146). Although the total higher-order aberrations did not significantly change after both procedures, the group comparison showed a significant difference in surgically induced total higher-order aberrations (a decrease of 0.337 ± 1.156 mm in 2.2-mm coaxial micro-incision cataract surgery and an increase of 0.106 ± 0.521 mm in 2.75-mm coaxial small-incision cataract surgery, p=0.046). Spherical aberrations significantly decreased after 2.2-mm coaxial micro-incision cataract surgery (p=0.001), whereas they did not change significantly after 2.75-mm coaxial small-incision cataract surgery (p=0.564). Coma did not significantly change after either of the procedures. Trefoil did not significantly change after 2.2-mm coaxial micro-incision cataract surgery (p=0.361), whereas it significantly increased after 2.75-mm coaxial small-incision cataract surgery (p<0.001). There was no significant difference shown in effective phaco time between the procedures. A significantly positive correlation was shown between surgically induced anterior corneal astigmatism and coma in 2.75-mm coaxial small-incision cataract surgery (r=0.387, p=0.006). There was no significant correlation found between any surgically induced higher-order aberration changes and effective phaco time. The results showed that 2.2-mm coaxial micro-incision cataract surgery and 2.75-mm coaxial small-incision cataract surgery did not significantly degrade the total higher-order aberrations of the anterior cornea. However, the surgically induced changes in total higher-order aberration showed a significant difference between the two procedures, with a slight reduction after 2.2-mm coaxial micro-incision cataract surgery and a slight increase after 2.75-mm coaxial small-incision cataract surgery. Phaco time and power used during surgery had no impact on corneal aberrations.

Outcomes of coaxial microincision cataract surgery versus conventional phacoemulsification surgery

Aim: To compare surgical parameters and visual outcomes of coaxial microincision cataract surgery (MICS) with standard phacoemulsification.&#x0D; Methods: A prospective randomized study was conducted on 60 eyes of 60 patients with age-related uncomplicated cataract who underwent: standard phacoemulsification surgery (30 eyes) i.e., Group 1, or coaxial MICS (30 eyes) i.e., Group 2. Intraoperative parameters were mean effective phacoemulsification power (EPP), effective phacoemulsification time (EPT), and total volume of balanced salt solution (BSS) used. Best-corrected visual acuity (BCVA) and surgically induced astigmatism (SIA) were evaluated pre- and postoperatively.&#x0D; Results: Mean BCVA at 6 weeks was 0.04 ± 0.07 in Group 1 and 0.05 ± 0.08 in Group 2. No significant difference was observed in SIA between the two groups. Mean EPT was 29.80 ± 3.67 seconds in Group 1 and 31.93 ± 4.08 seconds in Group 2. The mean total EPP in Group 1 was 35.77 ± 5.17%, whereas it was 33.70 ± 3.05% in Group 2. There was a significant statistical difference between mean EPP and EPT in the two groups. Mean total BSS volume used in Group 1 was 128.83 ± 19.81 ml, whereas it was 139.33 ± 13.57 ml in Group 2.&#x0D; Conclusion: Although EPT and BSS volume used were significantly higher in coaxial MICS, the postoperative results of the two techniques were comparable.

1.8-mm coaxial microincision cataract surgery with the Stellaris Vision Enhancement System

The purpose of this review is to analyse the benefits of phacoemulsification with 1.8-mm coaxial microincision cataract surgery using the Stellaris Vision Enhancement System. The Stellaris operating system and its advantages are explained and analysed. Other techniques are also referred to. The surgical technique of 1.8-mm microincision cataract surgery using Stellaris is described and some essential and helpful tips are explained. The Stellaris Enhancement System makes 1.8-mm microincision cataract surgery fast and easy for the surgeon, leading to high rates of patient satisfaction from the first postoperative days.

Bimanual Microincision Cataract Surgery versus Coaxial Microincision Cataract Surgery: A Meta-Analysis of Randomized Controlled Trials and Cohort Studies.

Purpose This meta-analysis was conducted to compare the intraoperative and postoperative outcomes of bimanual microincision cataract surgery (B-MICS) and coaxial microincision cataract surgery (C-MICS). Methods Three databases were searched for papers that compared B-MICS and C-MICS from inception to June 2016. The following intraoperative and postoperative outcomes were included in the final meta-analysis: ultrasound time (UST), effective phacoemulsification time (EPT), balanced salt solution use (BSS use), mean surgery time, best-corrected visual acuity (BCVA), central corneal thickness (CCT), and increased CCT. Results There were no statistically significant differences in mean surgery time, UST, BSS use, BCVA, CCT, or increased CCT (one subgroup at postoperative day 7-8 and another subgroup at postoperative day 30). However, there was less EPT needed during surgery (p < 0.01) and lower levels of increased CCT at postoperative day 1 (p = 0.02) in the B-MICS group compared with the C-MICS group. Conclusions The EPT was shorter and increased CCT was less at postoperative day 1 in the B-MICS group. There were no statistically significant differences in other intraoperative and postoperative outcomes between the B-MICS group and the C-MICS group. B-MICS is an efficient and safe cataract surgery procedure.

Topography changes and endothelial cell loss after temporal 1.8 mm coaxial microincision cataract surgery (MICS)

INTRODUCTION. The purpose of this paper was to determine surgically-induced changes both in corneal topographic parameters and in endothelial cell loss after coaxial microincision cataract surgery (MICS) through temporal 1.8 mm incision. MATERIALS AND METHODS. Evaluation was performed in forty eyes of thirty patients who underwent cataract sur­gery. Topographic parameters including corneal astigmatism, surface regularity index (SRI), and surface asymmetry index (SAI) were estimated preoperatively and at one week, four weeks, and eight weeks after surgery. A specular microscope was also used for the measurement of the corneal endothelial density (cells/mm 2 ). The surgically-induced astigmatism (SIA) was calculated by means of vector analysis using Alpins’ method. RESULTS. Eight weeks after surgery the final mean value of SIA was 0.42 D and the differences in topographic parameters such as corneal astigmatism, SRI, and SAI were not statistically significant. Also, the decrease in endothelial cell density eight weeks after surgery was 6.02%. CONCLUSIONS. The changes in SIA and topographic parameters after temporal coaxial 1.8 mm MICS are minimal throughout an eight-week follow up period.

Corneal biomechanical properties changes after coaxial 2.2-mm microincision and standard 3.0-mm phacoemulsification.

To compare the changes in corneal biomechanics measured by ocular response analyzer (ORA) after 2.2-mm microincision cataract surgery and 3.0-mm standard coaxial phacoemulsification. The prospective nonrandomized study comprised eyes with cataract that had 2.2-mm coaxial microincision or 3.0-mm standard incision phacoemulsification. The corneal hysteresis (CH), corneal resistance factor (CRF), corneal-compensated intraocular pressure (IOPcc) and Goldmann-correlated intraocular pressure (IOPg) were measured by ORA preoperatively and at 1d, 1-, 2-, 3- and 4-week postoperatively. Results were analyzed and compared between groups. In both groups, CH decreased in the immediate postoperative period (P<0.05), returned to the preoperative level at one week (P=0.249) in the 2.2-mm group, and at two weeks in the 3.0-mm group (P=0.264); there was no significant change in CRF values. In 2.2-mm group, mean IOPcc and IOPg increased at 1d postoperatively (both P<0.05), and returned to preoperative level at one week (P=0.491 and P=0.923, respectively). In 3.0-mm group, mean IOPcc and IOPg increased at 1d and 1wk postoperatively (P=0.005 and P=0.029, respectively), and returned to preoperative level at 2wk (P=0.347 and P=0.887, respectively). Significant differences between preoperative and postoperative corneal biomechanical values were found for CH, IOPcc and IOPg. But the recovery time courses were different between the two groups. The 2.2-mm coaxial microincision cataract surgery group seemed recovery faster compared to the 3.0-mm standard coaxial phacoemulsification group.

Effect of biaxial versus coaxial microincision cataract surgery on optical quality of the cornea.

Context:Visual function is determined by a combination of the cornea, which has a larger effect and internal aberrations generated by the intraocular lens and those induced by the surgery. These corneal refractive changes are related to the location and size of the corneal incision. The smaller the incision, the lower the aberrations and the better the optical quality.Aims:To compare the effect of uneventful coaxial versus biaxial microincision cataract surgery (MICS) on the corneal aberrations.Settings and Design:Retrospective interventional nonrandomized comparative case study comprised 40 eyes of 36 patients with primary senile cataract.Subjects and Methods:They were divided into two groups: Group I (20 eyes) had operated by biaxial MICS and Group II (20 eyes) had operated by coaxial MICS. Each group were assessed by corneal topography and wavefront analysis over 6 mm pupil size preoperatively and 1-month postoperatively.Statistical Analysis Used:Statistical analysis was performed using SPSS for Windows (version 17.0.1, SPSS, Inc.). The paired t-test was used to compare the mean values of corneal aberrations preoperatively and 1-month postoperatively in each group.Results:There was a significant increase in trefoil and quatrefoil in biaxial MICS (P = 0.063, 0.032 respectively) while other aberrations insignificantly changed. The coaxial MICS showed a significant increase in root mean square (RMS) of total high order aberrations (HOAs) (P = 0.02) and coma (0.028), but not the others. In comparison to each other, there was the insignificant difference as regards astigmatism, RMS of individual and total HOAs.Conclusions:Coaxial and biaxial MICS are neutral on corneal astigmatism and aberrations.

Biaxial vs Coaxial Microincision Cataract Surgery on the Quality of the Cornea

Biaxial vs Coaxial Microincision Cataract Surgery on the Quality of the Cornea

Change in Central Macular Thickness after 2.2-mm Microincision Coaxial versus 2.75-mm Small Incision Cataract Surgery

Purpose: To evaluate the central macular thickness and volume changes after conventional 2.75-mm small incision cataract surgery (SICS) and 2.2-mm microincision coaxial cataract surgery (MICS). Methods: We performed a retrospective chart review of 48 eyes undergoing uneventful phacoemulsification and divided the subjects into two groups, SICS and MICS. To evaluate the central macular thickness and volume changes after cataract surgery, optical coherence tomography (OCT) was used before and at one day, one week, one month, and two months postoperatively. Results: No statistically significant difference was found in the intraoperative phacoemulsification power, phaco time, or volume of intraoperative irrigation solution between the two groups (p > 0.05). The average central macular thickness increased in the MICS group compared to the SICS group at every postoperative time point, and the difference was statistically significant at postoperative one month (p = 0.04). The average central macular volume was elevated in the MICS group; however, the difference was not significant (p > 0.05). Conclusions: Central macular thickness and volume change were greater in the MICS group compared to the SICS group, and the difference in central macular thickness between the two groups was significant at postoperative one month. Careful follow-up examinations should be performed using OCT at this postoperative time point, especially in patients who received cataract surgery with smaller incision size. J Korean Ophthalmol Soc 2014;55(10):1460-1469

OUTCOMES AFTER COMBINED 1.8-MM MICROINCISION CATARACT SURGERY AND 23-GAUGE TRANSCONJUNCTIVAL VITRECTOMY FOR POSTERIOR SEGMENT DISEASE

The aim of the study was to retrospectively review indications, intraoperative and postoperative complications, and outcomes of combined coaxial microincision cataract surgery and 23-gauge vitrectomy for posterior segment disease. The outcomes and findings of surgery in 50 patients (50 eyes) who underwent coaxial microincision cataract surgery and foldable intraocular lens implantation combined with 23-gauge vitrectomy for a variety of indications between January 2010 and March 2012. No posterior capsule tear was observed during surgery. Intraoperatively, a retinal break was found in 9 eyes (18%), which were successfully treated with laser and/or cryotherapy. Corneal suture was done in 6 eyes (12%), 5 of them left and 1 right. Sclerotomy was sutured in 2 left and 2 right eyes, respectively, a total of 4 eyes (8%). In 1 case, 23-gauge vitrectomy was converted to 20-gauge vitrectomy. The postoperative intraocular pressure (millimeters of mercury, mean ± standard deviation) was 16.7 ± 9.8. Hypotony (intraocular pressure < 9 mmHg) occurred in 9 eyes (18%). In 1 eye (2%) posterior iris synechia were observed 2 weeks after surgery, and intraocular pressure was >40 mmHg. Intraocular pressure was normalized after Nd:YAG laser iridotomy. Fibrin reaction in the anterior chamber was observed in 1 eye (2%) Day 1 after surgery. Posterior capsule opacification, which required Nd:YAG laser capsulotomy, was observed in 11 eyes (22%) during the follow-up. Combined sutureless coaxial microincision cataract surgery and 23-gauge vitrectomy offers the advantages of both coaxial microincision cataract surgery (less wound leakage, good anterior chamber stability, and safety) and 23-gauge vitrectomy (decreased inflammation and faster rehabilitation after surgery).

極小切開白内障手術での眼内レンズ挿入後創口拡大

極小切開白内障手術下で眼内レンズ (IOL) 挿入前後の創口幅を検討した。極小切開白内障手術を行なった138眼にNY-60をN18カートリッジで, SN60ATをCカートリッジで, ZCB00とSN60WFをDカートリッジで挿入した。IOL挿入後創口幅は, NY-60が2.33mm (2.2mm角膜切開), 2.30mm (2.1mm角膜切開), 2.26mm (2.0mm角膜切開), 2.24mm (1.9mm角膜切開), SN60ATが2.34mm (2.2mm角膜切開), 2.43mm (2.2mm強角膜切開), SN60WFが2.34mm (2.2mm角膜切開), 2.29mm (2.1mm角膜切開), 2.20mm (2.0mm角膜切開), 2.11mm (1.9mm角膜切開), ZCB00が2.33mm (2.2mm角膜切開), 2.27mm (2.1mm角膜切開), 2.33mm (2.1mm強角膜切開), 2.29mm (2.0mm強角膜切開) であった。IOL挿入後創口は全例で拡大した。各IOL挿入システムの推奨切開幅は挿入可能な切開幅であり挿入による創への負担の無い切開幅ではない。

Short-Term Outcomes of Coaxial Microincision Cataract Surgery for Uveitis-Associated Cataract without Postoperative Systemic Steroid Therapy

Purpose: To study the necessity of prophylactic systemic steroid therapy after coaxial microincision cataract surgery (MICS) conducted in aged patients during remission of uveitis. Procedures: A total of 17 consecutive patients who underwent MICS were enrolled in this retrospective study. The median age was 73 years. MICS via a 2.2-mm incision was performed. None of the patients received systemic steroid administration after surgery. The visual acuity, intraocular pressure (IOP) and inflammation scores were recorded. Results: The mean logMAR visual acuity was significantly improved from 0.56 ± 0.58 to 0.10 ± 0.30, and the mean inflammation score was reduced from 0.20 to 0.14. Postoperative complications were recurrence of ocular inflammation in 1 eye and elevation of IOP more than 21 mm Hg in 1 eye, which were resolved by topical steroids and topical antiglaucoma medication. Conclusions: Prophylactic systemic steroid therapy after MICS may not be necessary in aged uveitis patients without posterior complications before cataract surgery.

Temperature profiles of sleeveless and coaxial phacoemulsification

To study the temperature profile at the corneal wound during 2 sleeveless techniques versus 2 coaxial phacoemulsification techniques. Department of Ophthalmology, Meir Medical Center, Kfar Saba and Ein-Tal Eye Center, Tel-Aviv, Israel. Experimental study. Thirty-six porcine eyes were randomized into 4 groups: Group 1: conventional coaxial system (3.0 mm incision); Group 2: coaxial microincision cataract surgery (MICS) system (2.2 mm incision); Group 3: bimanual MICS (1.1 mm incision); Group 4: sleeveless tri-MICS (1.1 mm incision) using a 19-gauge anterior chamber maintainer as the sole fluid source. Temperature measurements were taken using a thermocouple and an infrared thermal imaging system. Measurements were taken in 2 settings; that is, with and without occlusion. With no occlusion, corneal burns did not occur in any group. However, corneal temperatures were lower with the sleeveless systems (Groups 3 and 4) than with the coaxial systems (Groups 1 and 2) (P=.0003). When occlusion was induced, temperatures were kept constantly low in the sleeveless groups, whereas in the coaxial groups, temperatures increased rapidly, causing corneal burns within seconds. The mean temperature elevations at the incision sites were 39 °C, 48.5 °C, 13.6 °C, and 11.3 °C in Groups 1, 2, 3, and 4, respectively (P<.0001). Sleeveless phacoemulsification maintained lower tissue temperatures than sleeved coaxial methods. During occlusion, fluid flow around the naked tip of the sleeveless systems prevented heat accumulation and corneal burns.

Comparison of phaco-chop, divide-and-conquer, and stop-and-chop phaco techniques in microincision coaxial cataract surgery

To compare the outcomes of coaxial microincision cataract surgery (MICS) performed with 3 phacoemulsification techniques (phaco-chop, divide-and-conquer, and stop-and-chop) according to cataract density. Bucheon St. Mary's Hospital, College of Medicine, Catholic University of Korea, Seoul, South Korea. Prospective randomized clinical trial. Eyes with nuclear density from grade 2 to 4 were randomly subdivided into 3 groups (phaco-chop, divide-and-conquer, and stop-and-chop). Intraoperative measurements included ultrasound time (UST), mean cumulative dissipated energy (CDE), and balanced salt solution use. Clinical measurements included preoperative and 1 day, 1 month, and 2 month postoperative corrected distance visual acuity, central corneal thickness, and endothelial cell count. Intraoperative measurements showed significantly less UST, CDE, and balanced salt solution use with the phaco-chop technique than with the divide-and-conquer and stop-and-chop techniques in the grade 4 cataract density group (P<.05). The percentage of endothelial cell loss was significantly lower in the phaco-chop group than in the divide-and-conquer and stop-and-chop groups in the grade 4 cataract density group 2 months after cataract surgery (P<.05). All 3 techniques may be effective for coaxial MICS in mild and moderate cataracts. However, in eyes with hard cataract having coaxial MICS, the phaco-chop technique can be more effective for lens removal, with less corneal endothelial damage, than the divide-and-conquer and stop-and-chop techniques. No author has a financial or proprietary interest in any material or method mentioned.

Quantitative measurement of wound architecture in microincision cataract surgery

To evaluate whether changes in internal wound architecture after phacoemulsification can be measured quantitatively by analysis of scanning electron micrographs. Baylor College of Medicine, Houston, Texas, USA. Experimental study. Two comparative studies in human cadaver eyes were performed using coaxial small-incision cataract surgery (SICS), bimanual microincision cataract surgery (MICS), coaxial MICS, and a variety of phacoemulsification tips (MicroSurgical Technologies, Microphaco Tapered, Microtip Turbosonics, and Microphaco Mackool). After surgery, the cornea and scleral rims were harvested and digital scanning electron micrographs were taken. The internal corneal wound was analyzed using measurement software to determine the area of endothelial cell loss and length of Descemet membrane tears. Quantifiable differences were observed between combinations of techniques and tip designs. The mean area of endothelial cell loss was 2.93 ± 0.31 mm(2) (SD) after coaxial MICS (n = 4) and 2.85 ± 0.54 mm(2) after bimanual MICS (n = 4). However, after normalizing for differences in tip or sleeve diameter, the area of endothelial cell loss ranged from 1.4-fold to 1.7-fold less with coaxial SICS than with bimanual MICS with Microphaco Tapered, Microtip Turbosonics, and Microphaco Mackool tips. The mean total length of tearing was 1.38 ± 0.38 mm for bimanual MICS (n = 4) and 0.84 ± 0.61 mm for coaxial MICS (n = 4). The length and area of corneal wounds could be quantitated with accuracy and the measurements could be used to make quantifiable comparisons of phacoemulsification techniques and tips. Dr. Dimalanta is an employee of Alcon Research, Ltd. No other author has a financial or proprietary interest in any material or method mentioned.

Astigmatic Neutrality in 1.9-mm Coaxial Microincision Phacoemulsification

[Extract] Coaxial micro incision cataract surgery (MICS) can now be performed through similar incision sizes to those previously achieved using sleeveless biaxial MICS, ie,<2 mm. However, measurement variation of corneal astigmatism either by keratometers or topographers may mask the astigmatic effect of such small incisions, necessitating the use of a control sample when studying their effect. Knowing that biaxial MICS is astigmatically neutral, we set out to assess the astigmatic effect of coaxial MICS in a sufficiently powered study, controlling for observer variation of keratometry readings

Comparison of tips in coaxial microincision cataract surgery with the bevel-down technique

To compare clinical and intraoperative parameters of 3 phaco tip designs in torsional phacoemulsification using the bevel-down technique. Department of Ophthalmology and Visual Science, Seoul St. Mary's Hospital, College of Medicine, Catholic University of Korea, Seoul, South Korea. Clinical trials. Consecutive cases were randomly assigned to have coaxial microincision cataract surgery using the mini-flared 30-degree Kelman tip, mini-flared 45-degree Kelman tip, or reverse mini-flared 30-degree Kelman tip. Clinical measurements included preoperative and 2-month postoperative uncorrected distance visual acuity, endothelial cell counts, and anterior segment optical coherence tomography and preoperative and 1-day postoperative central corneal thickness. Intraoperative measurements included cumulative dissipated energy (CDE) and balanced salt solution use. Intraoperative video recording was used to visualize tip movements in the anterior chamber. The study enrolled 302 eyes of 297 patients. Intraoperatively, there was less CDE use with the 45-degree Kelman tip and reverse 30-degree Kelman tip than with the 30-degree Kelman tip (P<.05). There were no statistically significant differences in any clinical parameter between the 3 tips. Intraoperative films showed that the opening of the reverse 30-degree Kelman tip approached the nucleus more easily than the opening of the other 2 tips. In torsional phacoemulsification through microincisions with the bevel-down technique, the reverse mini-flared 0.9 mm 30-degree Kelman tip was as effective as the mini-flared 0.9 mm 45-degree Kelman tip with regard to intraoperative characteristics, such as total energy use. No author has a financial or proprietary interest in any material or method mentioned.

3 years of presbyopia surgery with a toric bifocal MICS IOL (BIOL) after coaxial microincision cataract surgery (CO-MICS)

3 years of presbyopia surgery with a toric bifocal MICS IOL (BIOL) after coaxial microincision cataract surgery (CO-MICS)

Combined occlusion-triggered longitudinal and torsional phacoemulsification during coaxial microincision cataract surgery: Effect on 30-degree mini-flared tip behavior

To study the impact of a new power-delivery option using occlusion-triggered bursts of longitudinal phaco energy in addition to torsional tip movement in the performance of the 30-degree mini-flared tip to minimize tip clogging with dense nuclei. Prince Charles Eye Unit, King Edward VII Hospital, Windsor, United Kingdom. Comparative case series. The cumulative dissipated energy (CDE) and time in foot pedal position 3 (FP3) to phacoemulsify each half of the nucleus with and without use of the new power-delivery option (Intelligent Phaco) were compared. Fifty consecutive cataract operations were reviewed. The mean CDE was 1.79 with the new power-delivery option and 2.03 without the option (P=.08). For grades I, II, III, and IV nuclei, the corresponding values were 0.41 and 0.51 (P=.16), 1.43 and 1.23 (P=.31), 2.32 and 2.92 (P=.12), 3.82 and 5.03 (P=.005). The mean FP 3 time was 5.40 seconds with the new power-delivery option and 6.35 seconds without it (P=.03). For grades I, II, III, and IV nuclei, the corresponding values were 1.53 seconds and 1.98 seconds (P=.13), 4.47 seconds and 4.26 seconds (P=.69), 6.51 seconds and 8.77 seconds (P=.05), 11.81 seconds and 16.49 seconds (P=.008). The new power-delivery option appeared to reduce the CDE and FP 3 time when a 30-degree mini-flared tip was used. The benefit accrued by preventing clogging of the needle was significant only in cases with a denser nucleus.

Microcoaxial Torsional Cataract Surgery 1.8 mm Versus 2.2 mm: Functional and Morphological Assessment

To compare functional and morphological outcomes of 1.8-mm versus 2.2-mm microincision coaxial cataract surgery (MCCS). Thirty eyes of 30 patients that underwent MCCS were randomized to two groups: 1.8-mm MCCS (group 1: 15 eyes) and 2.2-mm MCCS (group 2: 15 eyes). There were no significant between-group differences in uncorrected visual acuity, best-corrected visual acuity, keratometric astigmatism, and endothelial cell count. One day postoperatively, a greater increase of corneal thickness at the incision site was observed in group 1 compared to group 2 using anterior segment optical coherence tomography with no significant differences in tunnel morphometric features and confocal microscopy showed more tunnel edema in group 1 versus group 2 that resolved in both groups. Both 1.8- and 2.2-mm torsional MCCS were safe and efficient with easy surgical maneuvers and excellent functional and morphological results; 1.8-mm MCCS induced slightly greater tunnel edema shortly after surgery that resolved in the medium term.