Phaco Tip 120:
Phaco Incision: How Small?

The goals of small incision surgery are to provide rapid improvement in acuity via a safer and more efficient procedure. Virtually immediate recovery of vision is commonplace with topical anesthesia, yet the potential for further improvement still exists i.e. there are small incisions, and there are smaller incisions. Most surgeons agree that, at approximately 3.0 mm, the incidence of surgically induced astigmatism is minimal. However, subtle differences in the intraoperative behavior of eyes with incisions of 3.0 mm or greater and those with even smaller incisions do exist. For example, an incision of 3.0 - 3.4 mm will often take a minute or two to self-seal, whereas an incision of 2.8 mm will self-seal immediately in the vast majority of cases. Also, there is consistent loss of endothelial cells for 160 microns surrounding a corneal incision. The smaller the incision, the smaller this area of cell loss.

Finally, it is more efficient to utilize only one incision size for both the phacoemulsification and intraocular lens implantation. This is now routine; I currently use a 2.75 mm incision for both phaco (Mackool ABS^® flare tip) and IOL insertion (MONARCH^® II injector, SA-30 acrylic IOL). Other injectors and IOLs can be used through incisions of similar size.

* Phaco Tip TM of Richard J. Mackool, M.D.

The parameters (instrument settings) and incision size presented here have been established by the surgeon and do not reflect recommendations by Alcon.