[2 years corneal small-incision surgery. Results and indications]

Small-incision surgery has contributed considerably to accelerated wound healing and minimization of surgically induced astigmatism. A variation of this surgical technique is sutureless cornea small-incision surgery with preparation of a corneal tunnel of 4.5 mm or less. To date, 195 patients have been operated on with this technique. In 130 cases the incision was made in the upper temporal area, in 65 cases laterally. Visual outcome and development of induced astigmatism over a period of 2 years were compared with the results achieved with corneoscleral small-incision surgery. Four weeks postoperatively, the vision in all three groups was > 0.5 in 67% of the patients. Also in the further course no significant changes were found. Regarding the average astigmatism, more severe fluctuations during the whole follow-up period and approximately 0.4 D higher values were observed with clear corneal incision via an oblique meridian at the same initial value. After 2 years, the value found in this group was 1.5 +/- 0.7 D. The development of surgically induced astigmatism, determined according to Jaffe and Clayman, indicates the same relationship. Following clear corneal incision in the upper temporal area, the value decreased within 1 year postoperatively to an average of 0.85 +/- 0.55 D, followed by an increase after 2 years to 1.26 +/- 0.44 D, in contrast to a temporal or corneoscleral approach, where no severe fluctuations were found. Based on our experience, we only apply clear corneal incisions via the oblique or vertical meridian when try to correct preexisting astigmatism. Corneoscleral small-incision surgery remains our standard operation technique. If corneoscleral tunneling is not possible or is unfavorable, a clear corneal incision is placed laterally.