Different-sized incisions for phacoemulsification in age-related cataract

Area of Science:

• Ophthalmology
• Surgical Innovation
• Evidence-Based Medicine

Background:

• Age-related cataract is a leading cause of global vision impairment.
• Phacoemulsification is the standard surgical treatment for cataracts.
• The impact of incision size on phacoemulsification outcomes requires clarification.

Purpose of the Study:

• To systematically review the effectiveness and safety of smaller versus larger incisions in phacoemulsification for age-related cataracts.
• To assess surgically induced astigmatism as the primary outcome at three months post-surgery.

Main Methods:

• Conducted a systematic review of randomized controlled trials (RCTs).
• Searched multiple databases including CENTRAL, MEDLINE, Embase, PubMed, and LILACS without date or language restrictions.
• Included 26 RCTs involving 2737 participants comparing incision sizes from <= 1.5 mm to approximately 3.0 mm.

Main Results:

• Coaxial microincision phacoemulsification (C-MICS) showed a small, uncertain reduction in astigmatism compared to standard phacoemulsification.
• No consistent association found between smaller incisions and reduced surgically induced astigmatism.
• Evidence on visual acuity, endothelial cell loss, and corneal thickness showed little to no significant differences between most incision sizes.

Conclusions:

• Smaller incisions in phacoemulsification do not consistently reduce surgically induced astigmatism.
• The potential benefits of microincision techniques require further investigation due to uncertain evidence.
• Future research should prioritize reporting on safety outcomes and patient quality of life.