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Clear corneal incision, an important step in modern cataract surgery: a review

Eye volume 37, pages 2864–2876 (2023)Cite this article

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Abstract

A clear corneal incision (CCI) is the most commonly used entrance site in modern phacoemulsification cataract surgery. Despite some initial concerns about increased endophthalmitis rates through a self-sealing CCI, recent literature suggests that the risk of infection with proper wound construction and all other necessary precautions is minimal. The technique of creating a clear corneal incision has, with recent developments in corneal imaging, undergone critical appraisal leading to a better understanding of incision architecture. Many surgeons operate through smaller incisions, and they have a wide choice of surgical instruments to create their corneal incisions. The aim of this review is to discuss the history and the current status of clear corneal incision creation, the design and materials of surgical blades, and the current trends in manufacturing and sustainability. Although disposable instruments have some advantages and are very popular, recycling, if possible, and avoiding unnecessary plastic waste are important considerations. In any case, the step of CCI is a small one for the surgeon, but a big one for the eye. That is why it has to be done with the utmost precision and in-depth knowledge is important.

摘要

透明角膜切口 (CCI) 是现代超声乳化白内障术中最常用的手术切口。最初人们担心自限愈合的CCI可能会增加眼内炎的并发率, 但近期的文献表明, 只要通过适当的切口结构和其他必要的预防措施, 感染的风险可降至最低。随着角膜成像技术的最新发展, 构建透明的角膜切口技术已经经过了关键性评估, 使人们对切口结构有了更好的认知。许多外科医生都通过较小的切口进行手术, 且利用多种手术器械来创建角膜切口。本综述的目的是讨论透明角膜切口创建的历史和现状, 手术刀片的设计和材料, 以及制造和可持续性的当前趋势。一次性手术器械包含很多优点且广受欢迎, 但回收和避免不必要的塑料垃圾仍是重要的考虑因素。

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Fig. 1: Sequence of surgical steps.
Fig. 2
Fig. 3: Schematic illustration.
Fig. 4: Profiles of CCI.
Fig. 5

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The authors confirm that the data supporting the findings of this review are available within the article.

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Authors and Affiliations

  1. Borkenstein and Borkenstein, Private Practice at Privatklinik Kreuzschwestern, Graz, Austria

    Andreas F. Borkenstein & Eva-Maria Borkenstein

  2. Lynton Cottage, Westley Mill, Nr. Binfield Bracknell, UK

    Richard Packard

  3. Department of Ophthalmology, Antwerp University Hospital, Edegem, Belgium

    Sorcha Ni Dhubhghaill

  4. Tennent Institute of Ophthalmology, Gartnavel General Hospital, Glasgow, UK

    David Lockington

  5. Ophthalmic Consultants of Long Island, Long Island, NY, USA

    Eric D. Donnenfeld

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Borkenstein, A.F., Packard, R., Dhubhghaill, S.N. et al. Clear corneal incision, an important step in modern cataract surgery: a review. Eye 37, 2864–2876 (2023). https://doi.org/10.1038/s41433-023-02440-z

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