To investigate wound characteristics and ultrastructural changes in the 2.2-mm and 2.8-mm main corneal incisions.

Forty-four eyes of 34 patients undergoing cataract surgery were randomized to receive a 2.2-mm or 2.8-mm main corneal incision. All incisions were evaluated 1, 7, and 30 days postoperatively using anterior segment optical coherence tomography. The angle, length, maximal thickness of the incision, and if present, corneal gap length and incision gap area were calculated. The existence of Descemet's membrane detachment was recorded.

The mean endothelial gap length and gap area of the 2.2-mm wound were larger than the 2.8-mm, with the only statistically significant difference observed on postoperative day 30 ( p = 0.015 and 0.027, respectively). There was no difference in the mean incision angle, length, and corneal thickness between the 2 incision sizes. The ratio of Descemet's membrane detachment increased with older age and low postoperative IOP, but not associated with incision size ( p < 0.05).

Both the 2.2-mm and 2.8-mm main corneal incisions showed excellent wound healing outcome without significant postoperative complications. Older patients with low postoperative IOP required a more careful wound care management. The incision parameters in the present study can be used as an indicator of the healing process to reduce wound-related complications.