Evolution of sclero-corneal tunnel healing in manual small incision cataract surgery: An anterior segment optical coherence tomography-based study

Purpose: To evaluate the architecture and healing of the sclera-corneal tunnel in manual small incision cataract surgery (MSICS) using anterior segment optical coherence tomography (AS-OCT) over one month. The study also aimed to correlate incision features with best-corrected visual acuity (BCVA) at one month. Methods: This prospective observational study was conducted over 18 months, involving 67 patients who underwent uneventful MSICS. AS-OCT was used to evaluate wound features such as epithelial cysts, endothelial misalignment, endothelial gaping, stromal coaptation loss, Descemet’s membrane detachment (DMD), and maximum corneal thickness at the internal edge of the tunnel at postoperative day 1, week 1, and month 1. Results: Increased corneal thickness was observed in all patients at the internal edge of the tunnel postoperatively. Patients with DMD and endothelial gaping had significantly higher corneal thickness ( P < 0.05). Endothelial misalignment was the most common imperfection observed throughout the follow-up period. Wound imperfections did not significantly impact structural integrity or BCVA but require further investigation regarding their effect on surgically induced astigmatism. Conclusion: AS-OCT is a valuable tool for noninvasive assessment of sclero-corneal wound healing post MSICS. Although imperfections like endothelial misalignment and gaping are common, they do not necessarily affect visual outcomes.