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Comparison of Microcoaxial with Standard Clear Corneal Incisions in Torsional Handpiece Cataract Surgery

Aim: To evaluate the effect of torsional handpiece incision size on phacodynamics and endothelial cell loss (ECL) in cataract surgery. Design: Prospective, observer-masked study at the Department of Ophthalmology and Visual Science, Catholic University of Korea, Seoul St. Mary’s Hospital, Seoul, Korea. Participants: This study was conducted on 60 eyes of 60 patients who underwent phacoemulsification. Methods: Cataract surgery was performed on 28 eyes using a 0.9-mm micro 45-degree Kelman ABS (aspiration bypass system) tip through a 2.8-mm standard incision, and on 32 eyes using a 0.9-mm mini-flared 45-degree Kelman ABS tip through a 2.2-mm microcoaxial incision. As main outcome measures, intraoperative phacodynamics (cumulative dissipated energy, CDE, and balanced salt solution, BSS, use), central corneal thickness (CCT) and endothelial cell count (ECC) were investigated. Results: The CDE was lower in the microcoaxial incision (2.2-mm) group than in the standard incision (2.8-mm) group (p = 0.038). The ECC loss at 6 months was significantly lower in the microcoaxial incision group than in the standard incision group (p = 0.048). There were no differences in BSS use or CCT between the two groups. Conclusions: Torsional ultrasound phacoemulsification using microcoaxial incision with a mini-flared tip resulted in less energy use and less ECL compared with standard incision with a micro tip.