Biaxial microincision versus coaxial small-incision cataract surgery in complicated cases

PURPOSE: To evaluate and compare the results of biaxial microincision and coaxial small-incision surgery in patients with cataract with coexisting exfoliation syndrome, uveitis, anterior or posterior synechias, phacodonesis, or previous intraocular surgery over an 8-week follow-up. SETTING: Department of Ophthalmology, Mainz University, Mainz, Germany. METHODS: Eyes were prospectively assigned (1:1) to have biaxial microincision (<1.5 mm) phaco-emulsification or coaxial small-incision (2.8 mm) phacoemulsification using pulsed ultrasound energy (Sovereign White Star) with variable duty cycles followed by implantation of a microincision intraocular lens. Intraoperative and postoperative complications, corrected distance visual acuity (CDVA), laser flare photometry values, effective phacoemulsification time (EPT), and endothelial cell count (ECC) were evaluated. RESULTS: The study enrolled 94 eyes. There were no statistically significant differences between the techniques in intraoperative or postoperative complications. The most frequent postoperative complications were corneal edema surrounding the incision (40%, biaxial group; 35%, coaxial group), pupil distortion (3% versus 7%), and fibrin exudation (3% versus 3%). No other postoperative complications occurred. The median EPT was statistically significantly shorter (1.34 seconds versus 5.4 seconds) and the median phaco power significantly lower (3.3% versus 12.9%) in the biaxial group than in the coaxial group (P<.001). There were no differences between groups in CDVA, laser flare photometry values, or FCC. CONCLUSIONS: The EPT was shorter and the mean phaco power lower with biaxial phacoemulsification, perhaps because of better access of the phaco handpiece for grooving the nucleus with this technique. The 2 techniques were comparable in intraoperative and postoperative complications.