Japanese Journal of Ophthalmology

, Volume 62, Issue 6, pp 621–627 | Cite as

Intraocular pressure and wound state immediately after long versus short clear corneal incision cataract surgery

  • Ken HayashiEmail author
  • Hiroshi Sasaki
  • Shin-ichi Manabe
  • Akira Hirata
Clinical Investigation



To compare the intraocular pressure (IOP) and wound state immediately after cataract surgery for eyes with a long clear corneal incision (CCI) with those for eyes with a short CCI.

Study design

Randomized clinical trial.


One hundred twenty-eight eyes of 128 patients scheduled for phacoemulsification were randomly assigned to undergo long (≥ 1.75 mm) or short (< 1.75 mm) CCI (2.4-mm wide). IOP was measured using a rebound tonometer preoperatively, at the conclusion of surgery, and at 30 min, 60 min, 120 min, 180 min, and 24 h postoperatively. Wound architecture determined using anterior segment-optical coherence tomography and flare intensity was examined at 60 min postoperatively.


The mean incision length was significantly longer in the long CCI group (2.02 ± 0.19 mm) than in the short CCI group (1.50 ± 0.13mm; P < .0001). The mean IOP significantly increased at 120 min and 180 min postoperatively (P ≤ .0005) and returned to the preoperative level within 24 h. The mean IOP did not differ significantly between the long and short CCI groups at any follow-up period. The incidence of IOP lower than 10 mmHg did not differ significantly between the groups. The mean flare intensity was significantly greater in the short CCI group than in the long CCI group (P = .0122). The wound architecture was similar between the groups.


IOP and wound architecture were comparable between eyes with a long CCI and eyes with a short CCI in the immediate postoperative periods up to 24 h, suggesting that wound stability is equivalent when the CCI is securely closed with wound hydration.


Intraocular pressure Phacoemulsification Long clear corneal incision Short clear corneal incision Wound construction 



The authors thank SciTechEdit International (Highlands Ranch, CO, USA) for editorial assistance and Kozi Yonemoto, PhD, (Ryukyu University, Okinawa, Japan) for statistical assistance.

Conflicts of interest

K Hayashi, Grant (Abbott Medical Optics, Alcon, HOYA, Santen Pharmaceutical, Wakamoto); H. Sasaki, Grant (Abbott Medical Optics, Alcon, HOYA, Santen Pharmaceutical, Wakamoto); S. Manabe, Grant (Abbott Medical Optics, Alcon, HOYA, Santen Pharmaceutical, Wakamoto); A. Hirata, Grant (Abbott Medical Optics, Alcon, HOYA, Santen Pharmaceutical, Wakamoto).


  1. 1.
    Sarayba MA, Taban M, Ignacio TS, Behrens A, McDonnell PJ. Inflow of ocular surface fluid through clear corneal cataract incisions: a laboratory model. Am J Ophthalmol. 2004;138:206–10.CrossRefGoogle Scholar
  2. 2.
    Herretes S, Stark WJ, Pirouzmanesh A, Reyes JM, McDonnell PJ, Behrens A. Inflow of ocular surface fluid into the anterior chamber after phacoemulsification through sutureless corneal cataract wounds. Am J Ophthalmol. 2005;140:737–40.CrossRefGoogle Scholar
  3. 3.
    Chawdhary S, Anand A. Early post-phacoemulsification hypotony as a risk factor for intraocular contamination: in vivo model. J Cataract Refract Surg. 2006;32:609–13.CrossRefGoogle Scholar
  4. 4.
    May W, Castro-Combs J, Camacho W, Wittmann P, Behrens A. Analysis of clear corneal incision integrity in an ex vivo model. J Cataract Refract Surg. 2008;34:1013–8.CrossRefGoogle Scholar
  5. 5.
    McDonnell PJ, Taban M, Sarayba M, Rao B, Zhang J, Schiffman R, et al. Dynamic morphology of clear corneal cataract incisions. Ophthalmology. 2003;110:2342–8.CrossRefGoogle Scholar
  6. 6.
    Berdahl JP, DeStafeno JJ, Kim T. Corneal wound architecture and integrity after phacoemulsification: evaluation of coaxial, microincision coaxial, and microincision bimanual techniques. J Cataract Refract Surg. 2007;33:510–5.CrossRefGoogle Scholar
  7. 7.
    Calladine D, Packard R. Clear corneal incision architecture in the immediate postoperative period evaluated using optical coherence tomography. J Cataract Refract Surg. 2007;33:1429–35.CrossRefGoogle Scholar
  8. 8.
    Behrens A, Stark WJ, Pratzer KA, McDonnell PJ. Dynamics of small-incision clear cornea wounds after phacoemulsification surgery using optical coherence tomography in the early postoperative period. J Refract Surg. 2008;24:46–9.PubMedGoogle Scholar
  9. 9.
    Hayashi K, Yoshida M, Hirata A, Yoshimura K. Changes in shape and astigmatism of total, anterior, and posterior cornea after long- versus short corneal incision cataract surgery. J Cataract Refract Surg. 2018;44:39–49.CrossRefGoogle Scholar
  10. 10.
    Chylack LT Jr, Wolfe JK, Singer DM, Leske MC, Bullimore MA, Bailey IL, et al. The lens opacities classification system III: the longitudinal study Of Cataract Study Group. Arch Ophthalmol. 1993;111:831–6.CrossRefGoogle Scholar
  11. 11.
    Hayashi K, Ogawa S, Yoshida M, Yoshimura K. Wound stability and surgically induced corneal astigmatism after transconjunctival single-plane sclerocorneal incision cataract surgery. Jpn J Ophthalmol. 2017;61:113–23.CrossRefGoogle Scholar
  12. 12.
    Hayashi K, Tsuru T, Yoshida M, Hirata A. Intraocular pressure and wound status in eyes immediately after scleral tunnel incision and clear corneal incision cataract surgery. Am J Ophthalmol. 2014;158:232–41.CrossRefGoogle Scholar
  13. 13.
    Salim S, Du FH, Wan J. Comparison of intraocular pressure measurements and assessment of intraobserver and interobserver reproducibility with the portable ICare rebound tonometer and Goldmann applanation tonometer in glaucoma patients. J Glaucoma. 2013;22:325–9.CrossRefGoogle Scholar
  14. 14.
    Brusini P, Salvetat ML, Zeppieri M, Tosoni C, Parisi L. Comparison of ICare tonometer with Goldmann applanation tonometer in glaucoma patients. J Glaucoma. 2006;15:213–7.CrossRefGoogle Scholar
  15. 15.
    Sahin A, Basmak H, Niyaz L, Yildirim N. Reproducibility and tolerability of the ICare rebound tonometer in school children. J Glaucoma. 2007;16:185–8.CrossRefGoogle Scholar
  16. 16.
    Mackool RJ, Russell RS. Strength of clear corneal incisions in cadaver eyes. J Cataract Refract Surg. 1996;22:721–5.CrossRefGoogle Scholar

Copyright information

© Japanese Ophthalmological Society 2018

Authors and Affiliations

  • Ken Hayashi
    • 1
    Email author
  • Hiroshi Sasaki
    • 1
  • Shin-ichi Manabe
    • 1
  • Akira Hirata
    • 1
  1. 1.Hayashi Eye HospitalFukuokaJapan

Personalised recommendations