Journal List > J Korean Ophthalmol Soc > v.54(6) > 1009699

J Korean Ophthalmol Soc. 2013 Jun;54(6):877-886. Korean.
Published online June 14, 2013.
Copyright © 2013 The Korean Ophthalmological Society
The Morphological Changes in Main Corneal Incision (2.2 mm vs. 2.8 mm) Evaluated Using Anterior Segment Optical Coherence Tomography
Jin Hyung Kim, MD, Tae Im Kim, MD, PhD, Eung Kweon Kim, MD, PhD and Hyung Keun Lee, MD
The Institute of Vision Research, Department of Ophthalmology, Yonsei University College of Medicine, Seoul, Korea.

Address reprint requests to Hyung Keun Lee, MD. Department of Ophthalmology, Gangnam Severance Hospital, #211 Eonju-ro, Gangnam-gu, Seoul 135-720, Korea. Tel: 82-2-2019-3440, Fax: 82-2-3463-1049, Email:
Received June 22, 2012; Revised January 03, 2013; Accepted April 15, 2013.



To investigate wound characteristics and ultrastructural changes in the 2.2-mm and 2.8-mm main corneal incisions.


Forty-four eyes of 34 patients undergoing cataract surgery were randomized to receive a 2.2-mm or 2.8-mm main corneal incision. All incisions were evaluated 1, 7, and 30 days postoperatively using anterior segment optical coherence tomography. The angle, length, maximal thickness of the incision, and if present, corneal gap length and incision gap area were calculated. The existence of Descemet's membrane detachment was recorded.


The mean endothelial gap length and gap area of the 2.2-mm wound were larger than the 2.8-mm, with the only statistically significant difference observed on postoperative day 30 (p = 0.015 and 0.027, respectively). There was no difference in the mean incision angle, length, and corneal thickness between the 2 incision sizes. The ratio of Descemet's membrane detachment increased with older age and low postoperative IOP, but not associated with incision size (p < 0.05).


Both the 2.2-mm and 2.8-mm main corneal incisions showed excellent wound healing outcome without significant postoperative complications. Older patients with low postoperative IOP required a more careful wound care management. The incision parameters in the present study can be used as an indicator of the healing process to reduce wound-related complications.

Keywords: Anterior segment optical coherence tomography; Main corneal incision; Morphology; Phacoemulsification


Figure 1
Anterior segment OCT (optical coherence tomography) image showing a clear corneal incision site postoperatively. The definition of incision site parameters: 1) Incision angle (The angle between the line that joins the epithelial and endothelial ends of the incision and the tangential line on the corneal surface) 2) Incision length (The total length of the main incision measured from the wound entry to its exit point) 3) Epithelial/endothelial gap length (The length that lines inside of the gap, the longer one is selected, if present) 4) Epithelial/endothelial gap area (The area inside of the gap, if present) 5) Descemet's membrane detachment 6) Maximal corneal thickness at the incision site.
Click for larger image

Figure 2
Results of AS-OCT parameter, (A) Mean angle (°); (B) Mean length (µm); (C) Mean corneal thickness at incision site (µm); (D) Mean endothelial gap length (µm); (E) Mean endothelial gap area (µm2) (*p < 0.05).
Click for larger image

Figure 3
The ratio of postoperative Descemet's membrane detachment by age (*p < 0.05).
Click for larger image


Table 1
Preoperative patient characteristics
Click for larger image

Table 2
Comparison of mean surgical parameters between 2.2-mm and 2.8-mm incision group
Click for larger image

Table 3
Postoperative changes in mean UCVA and IOP and astigmatism by autorefractor
Click for larger image

Table 4
Results of AS-OCT parameters
Click for larger image

Table 5
The ratio of postoperative Descemet's membrane detachment by age
Click for larger image

Table 6
Parameters of groups with and without Descemet's membrane detachment
Click for larger image

1. Kelman CD. Phaco-emulsification and aspiration. A new technique of cataract removal. A preliminary report. Am J Ophthalmol 1967;64:23–35.
2. Crema AS, Walsh A, Yamane Y, Nosé W. Comparative study of coaxial phacoemulsification and microincision cataract surgery. One-year follow-up. J Cataract Refract Surg 2007;33:1014–1018.
3. Ku HC, Kim HJ, Joo CK. The comparison of astigmatism according to the incision size in small incision cataract surgery. J Korean Ophthalmol Soc 2005;46:416–421.
4. Jee DH, Lee PY, Joo CK. The comparison of astigmatism according to the incision size in cataract operation. J Korean Ophthalmol Soc 2003;44:594–598.
5. Nagaki Y, Hayasaka S, Kadoi C, et al. Bacterial endophthalmitis after small-incision cataract surgery: effect of incision placement and intraocular lens type. J Cataract Refract Surg 2003;29:20–26.
6. Eifrig CW, Flynn HW Jr, Scott IU, Newton J. Acute-onset postoperative endophthalmitis: review of incidence and visual outcomes (1995-2001). Ophthalmic Surg Lasers 2002;33:373–378.
7. Taban M, Behrens A, Newcomb RL, et al. Acute endophthalmitis following cataract surgery: a systematic review of the literature. Arch Ophthalmol 2005;123:613–620.
8. Miller JJ, Scott IU, Flynn HW Jr, et al. Acute-onset endophthalmitis after cataract surgery (2000-2004): incidence, clinical settings, and visual acuity outcomes after treatment. Am J Ophthalmol 2005;139:983–987.
9. Monica ML, Long DA. Nine-year safety with self-sealing corneal tunnel incision in clear cornea cataract surgery. Ophthalmology 2005;112:985–986.
10. Masket S. Is there a relationship between clear corneal cataract incisions and endophthalmitis? J Cataract Refract Surg 2005;31:643–645.
11. Wallin T, Parker J, Jin Y, et al. Cohort study of 27 cases of endophthalmitis at a single institution. J Cataract Refract Surg 2005;31:735–741.
12. Choi JA, Chung SK, Kim HS. Comparative study of microcoaxial cataract surgery and conventional cataract surgery. J Korean Ophthalmol Soc 2008;49:904–910.
13. Taban M, Rao B, Reznik J, et al. Dynamic morphology of sutureless cataract wounds--effect of incision angle and location. Surv Ophthalmol 2004;49 Suppl 2:S62–S72.
14. Torres LF, Saez-Espinola F, Colina JM, et al. In vivo architectural analysis of 3.2 mm clear corneal incisions for phacoemulsification using optical coherence tomography. J Cataract Refract Surg 2006;32:1820–1826.
15. Fine IH, Hoffman RS, Packer M. Profile of clear corneal cataract incisions demonstrated by ocular coherence tomography. J Cataract Refract Surg 2007;33:94–97.
16. Vasavada V, Vasavada V, Raj SM, Vasavada AR. Intraoperative performance and postoperative outcomes of microcoaxial phacoemulsification. Observational study. J Cataract Refract Surg 2007;33:1019–1024.
17. Osher RH, Injev VP. Microcoaxial phacoemulsification: Part 1: laboratory studies. J Cataract Refract Surg 2007;33:401–407.
18. Cavallini GM, Pupino A, Masini C, et al. Bimanual microphacoemulsification and Acri. Smart intraocular lens implantation combined with vitreoretinal surgery. J Cataract Refract Surg 2007;33:1253–1258.
19. Schallhorn JM, Tang M, Li Y, et al. Optical coherence tomography of clear corneal incisions for cataract surgery. J Cataract Refract Surg 2008;34:1561–1565.
20. Dupont-Monod S, Labbé A, Fayol N, et al. In vivo architectural analysis of clear corneal incisions using anterior segment optical coherence tomography. J Cataract Refract Surg 2009;35:444–450.
21. Calladine D, Tanner V. Optical coherence tomography of the effects of stromal hydration on clear corneal incision architecture. J Cataract Refract Surg 2009;35:1367–1371.
22. Elkady B, Piñero D, Alió JL. Corneal incision quality: Microincision cataract surgery versus microcoaxial phacoemulsification. J Cataract Refract Surg 2009;35:466–474.
23. McGowan BL. Mechanism for development of endophthalmitis. J Cataract Refract Surg 1994;20:111.
24. Can I, Bayhan HA, Celik H, Bostancı Ceran B. Anterior segment optical coherence tomography evaluation and comparison of main clear corneal incisions in microcoaxial and biaxial cataract surgery. J Cataract Refract Surg 2011;37:490–500.
25. Can I, Takmaz T, Genç I. Half-moon supracapsular nucleofractis phacoemulsification: Safety, efficacy, and functionality. J Cataract Refract Surg 2008;34:1958–1965.
26. Xia Y, Liu X, Luo L, et al. Early changes in clear cornea incision after phacoemulsification: an anterior segment optical coherence tomography study. Acta Ophthalmol 2009;87:764–768.