Coaxial, microcoaxial, and biaxial microincision cataract surgery. Prospective comparative study

Purpose: To compare the intraoperative and postoperative results of 3 phacoemulsification techniques. Setting: Atatürk Training and Research Hospital, 2nd Ophthalmology Department, Ankara, Turkey. Methods: In this prospective randomized study, patients had standard coaxial (2.8 mm incisions), microcoaxial (2.2 mm incisions), or biaxial microincision (1.2 to 1.4 mm trapezoidal incisions) phacoemulsification. Intraoperative phaco parameters and total surgical time were measured and complications recorded. Postoperative visual acuity improvement, pachymetric differences, and surgically induced astigmatism (SIA) results were compared. Results: Each group comprised 45 eyes. There were no significant differences between the 3 groups in demographic, morphologic, or preoperative surgical data. The mean effective phaco time was 2.56 seconds ± 2.46 (SD) in the standard coaxial group, 1.98 ± 1.91 seconds in the microcoaxial group, and 1.29 ± 1.85 seconds in the biaxial microincision group (P<.05). The mean total surgical time was 14.48 ± 4.21 minutes, 13.01 ± 3.66 minutes, and 18.79 ± 6.58 minutes, respectively (P<.01), and the mean measured final incision size was 2.83 ± 0.11 mm, 2.26 ± 0.07 mm, and 1.89 ± 0.21 mm, respectively. The mean SIA 90 days postoperatively was 0.46 diopter (D), 0.24 D, and 0.13 D, respectively (P<.01). There was no statistically significant difference in the complication rate, visual acuity gain, or pachymetric change between the groups (P>.05). Conclusions: All 3 techniques were reliable, functional, and effective, yielding good visual outcomes and low phaco parameters and complication rates. Biaxial microincision surgery, with the smallest incisions, induced less astigmatism and reduced all intraoperative phaco parameters except total surgical time. Financial Disclosure: No author has a financial or proprietary interest in any material or method mentioned.