Randomized Prospective Evaluation of the Wound Integrity of Primary Clear Corneal Incisions Made With a Femtosecond Laser Versus a Manual Keratome

Document Type


Publication Date

March 2018




PURPOSE: To compare the wound integrity of femtosecond laser-assisted 110-degree reverse side-cut clear corneal incisions (CCIs) with femtosecond laser-assisted 70-degree forward side-cut and manual CCIs in patients having cataract surgery. SETTING: Island Eye Surgicenter, Carle Place, New York, USA. DESIGN: Prospective case series. METHODS: Patients having cataract surgery were randomized into 3 treatment groups as follows: Group A had 110-degree femtosecond reverse side-cut CCIs, Group B had 70-degree femtosecond forward side-cut CCIs, Group C had manual CCIs. At the conclusion of surgery, the integrity of the CCI was measured by raising intraocular pressure (IOP) until the CCI began to leak. Postoperatively, the CCIs were assessed for wound leakage at 1 day, 2 weeks, and 1 month. RESULTS: The study comprised 45 patients (45 eyes, 15 in each treatment group). The mean IOP at which CCIs leaked (in response to anterior chamber balanced salt solution irrigation) was statistically significantly higher in Group A (28.20 mm Hg +/- 11.69 [SD]) than in Group B (15.07 +/- 10.64 mm Hg; P = .005) and Group C (9.93 +/- 9.90 mm Hg; P < .001). At 1 day postoperatively, the Seidel test with pressure showed no leakage in any of the Group A eyes; however, 53% of eyes in Group B and 87% in Group C showed wound leakage. CONCLUSION: The femtosecond laser-created reverse side-cut CCIs required significantly higher IOP intraoperatively before leaking and resulted in better wound integrity with significantly less wound leakage postoperatively than laser-created forward side-cut or manual CCIs.