OCT-Documented Incision Features and Natural History of Clear Corneal Incisions Used for Bimanual Microincision Cataract Surgery

Abstract

Purpose: Use of anterior segment OCT to identify features and natural history of bimanual incisions used only for phacoemulsification and a main incision used only for intraocular lens insertion. Methods: Prospective study of 25 subjects who had uncomplicated bimanual phacoemulsification. The Zeiss Visante OCT identified incisions at 1 day, 1 week, and 1 month postoperatively. The absence or presence of features, endothelial gaping, detachment of the Descemet membrane, endothelial misalignment, epithelial gaping, and/or loss of coaptation, was recorded. Main incision data were compared with bimanual incision data. The difference for each feature, between the main incision and the bimanual incision, at each time point and over time were calculated. Results: The most common findings at 1 day, 1 week, and 1 month were main incision endothelial misalignment (52%) and bimanual incision endothelial gape (24%), main incision endothelial misalignment (60%) and bimanual incision endothelial gape (22%), and main incision endothelial misalignment (35%) and bimanual incision endothelial misalignment (14%), respectively. Only at 1 day and 1 week was endothelial misalignment significantly more common in the main incision (P = 0.0352 and 0.0005, respectively). The only other incision feature that differed significantly was endothelial gape, which was more frequent in the bimanual incision at 1 week (P = 0.0391). For each incision feature combined over all time periods, only endothelial misalignment was significantly more prevalent in the main incision (P = 0.0004), whereas endothelial gape was more common in the bimanual incision (P = 0.0352). Conclusions: Using OCT, bimanual phacoemulsification did not adversely affect the anatomic incision integrity and healing.