ORIGINAL RESEARCH article
Front. Ophthalmol.
Sec. Cornea and Refractive Surgery
Comparison of 2.2 mm vs. 2.6 mm Corneal Incisions in Phacoemulsification in hard nuclear cataracts: Impact on Intraoperative Energy and Postoperative Corneal Recovery
Maierdanjiang Ainiwaer
Yingying Hong
Binghe Xiao
LI Ning
Yinghong Ji
Eye and Ent Hospital, Fudan University, Shanghai, China
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Abstract
Purpose: This study sought to evaluate the differential impacts of two corneal incision sizes, 2.2 mm and 2.6 mm, on the utilization of intraoperative ultrasound energy and the subsequent postoperative corneal recovery in patients presenting with hard nuclear cataracts. Methods: A retrospective cohort study was undertaken, encompassing cataract patients classified with nuclear hardness grades III to V according to the Emery-Little classification. Participants were allocated into two groups based on the incision size: 2.2 mm and 2.6 mm. Key metrics, including endothelial cell density (ECD), central corneal thickness (CCT), incisional corneal thickness (ICT), and best-corrected visual acuity (BCVA), were assessed preoperatively and at intervals of 1 day, 1 week, 1 month, and 3 months postoperatively. Additionally, intraoperative phacoemulsification parameters and any complications were documented. Results: The study encompassed a total of 100 eyes, with 50 eyes in each group. No statistically significant differences were detected in cumulative dissipated energy (CDE) or ultrasound time (UST) between the two groups (P > 0.05). Both groups exhibited a significant postoperative decline in ECD (P < 0.05), yet no significant intergroup difference was observed in the magnitude of this reduction (P > 0.05). Central corneal thickness (CCT) and intraocular pressure (ICT) exhibited a statistically significant increase at both 1 day and 1 week postoperatively when compared to baseline measurements (P < 0.05). Notably, the increase in ICT was significantly more pronounced in the 2.2 mm incision group at both time points (P < 0.05). Best-corrected visual acuity (BCVA) showed significant improvement in both groups following surgery (P < 0.05), with no significant intergroup differences observed at any follow-up interval (P > 0.05). Additionally, no significant difference in central corneal edema was detected between the two groups (P > 0.05). Conclusion: The corneal incision size (2.2 mm versus 2.6 mm) did not influence the use of intraoperative ultrasound energy or result in differential corneal endothelial cell loss. However, smaller incisions (2.2 mm) were associated with increased short-term edema at the incision site, potentially impacting early wound healing.
Summary
Keywords
Corneal Edema, corneal incision size, Hard nuclear cataract, incisional corneal thickness, Phacoemalsification
Received
25 October 2025
Accepted
17 February 2026
Copyright
© 2026 Ainiwaer, Hong, Xiao, Ning and Ji. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
*Correspondence: Yinghong Ji
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