Prospective randomized comparison of phacoemulsification cataract surgery with a 3.2-mm vs a 5.5-mm sutureless incision

Abstract

Purpose: To report sutureless cataract surgery by phacoemulsification with a 3.2-mm surgical incision compared with a 5.5-mm surgical incision.

Method: In a prospective, randomized, masked clinical trial of phacoemulsification cataract surgery, 55 eyes (55 patients) had a 3.2-mm incision and 56 eyes (56 patients) had a 5.5-mm incision. All incisions were in the superior vertical meridian, commenced 1.5 mm posterior to the limbus, and extended into the cornea for a total length of 2.5 to 3.0 mm. In a masked fashion, astigmatism was monitored by keratometry, and logMAR visual acuity was determined both with and without best correction throughout a mean follow-up of 33.9 months.

Results: Statistically significant differences were seen in favor of the 3.2-mm incision group at the final examination for astigmatism (Cravy analysis) and uncorrected visual acuity (-0.18 vs -0.88 diopter, P < .001; logMAR, 0.14 vs 0.26, P = .04).

Conclusions: Over the long term, phacoemulsification with a 3.2-mm incision is associated with significantly less astigmatic shift and better uncorrected visual acuity than is phacoemulsification with a 5.5-mm incision. A small incision with a foldable intraocular lens has long-term benefits.