#11: Clear Corneal Small Incision Cataract Surgery

Cataract surgery was once considered a difficult procedure that required hospital admission prior to surgery and patient compliance to complicated post-surgical instructions to achieve a satisfactory visual outcome. The introduction of clear corneal small incisions in cataract surgery dramatically reduced surgical time and patient recovery periods with no bleeding or need for sutures and less surgically induced astigmatism.

Intraoperative OCT image acquired with the VICTUS^(R) Femtosecond Laser Platform. The OCT module of the VICTUS platform is supplied by Heidelberg Engineering and allows for visualization during surgery.

Clear corneal incisions were first introduced by Dr. I. Howard Fine, Clinical Professor of Ophthalmology at the Oregon Health and Science University, in 1992. In that year, just 1.2% of respondents to an American Society of Cataract and Refractive Surgery survey said that they used clear corneal cataract incisions. This percentage jumped to 12.4% in 1995, 47% in 2000, and 72% in 2003 (the last year of published results for this question).

Since the introduction of this new procedure, single-plane clear corneal incisions have largely replaced sclerocorneal tunnel incisions in cataract surgery. The majority of leading surgeons use a temporal incision though some still prefer a superior approach. A variety of incision shapes and depths may be utilized during the procedures – these are often depending on surgeon preference. Optical coherence tomography may be used during and after clear corneal incisions to evaluate corneal incision length, angle of incision, distance between the incision and scleral spur, and other dimensions.

One of the ongoing debates surrounding clear corneal incisions involves the risk of endophthalmitis following cataract surgery. A number of papers and reviews have been published, often with conflicting results. The risk seems somewhat dependent on surgeon technique and experience.

Currently available femtosecond lasers typically offer the option for surgeons to use lasers to produce clear corneal incisions. Data is still accumulating regarding these incisions’ morphology and impact on surgically induced astigmatism.