Architectural analysis of clear corneal incision techniques in cataract surgery using Fourier-domain OCT

To compare the architecture of single plane self-sealing clear corneal incision (SP-CCI) and shallow grooved self-sealing clear corneal incision (SG-CCI) after cataract surgery using Fourier-domain optical coherence tomography (FD-OCT).

An FD-OCT system with a corneal adaptor module was used to image the corneal incisions in radial sections in 44 eyes. A line scan pattern was used to measure the corneal incision, positioning the caliper mark perpendicular to the limbus. Measurements were performed immediately after cataract surgery and at postoperative days 1, 7, and 30. Incisions were analyzed regarding length, location, angle, architecture, and anatomic imperfections.

All incisions were located superiorly (temporal, 24 eyes; nasal, 20 eyes). The mean SG-CCI length (20 eyes) was 1.79 ± 0.31 mm (range: 0.93-2.64 mm) and the mean incision angle was 37 ± 7 degrees (range: 24-34 degrees). The mean SP-CCI length (22 eyes) was 1.64 ± 0.22 mm (range: 1.25-2.36 mm) and the mean incision angle was 38.5 ± 5 degrees (range: 27-52 degrees) (P < .05). Anatomic imperfections were observed at postoperative day 1 in 19 eyes for SP-CCI and 14 eyes for SG-CCI. No patient presented endophthalmitis during 30 days of follow-up.

Epithelial imperfection at the corneal incision site was observed in more than 36% of the wounds (36% in SP-CCI and 45% in SG-CCI) at postoperative day 1 with spontaneous resolution. SG-CCI had the greatest length and lowest angle of corneal incision. Reduced incision length and inappropriate construction may determine risk factors for wound architectural imperfections. Further studies including more patients with an architectural analysis of clear corneal incisions are needed to confirm these preliminary results.