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SummaryEach step of a cataract procedure builds on the previous step; therefore to construct a successful operation, a stable foundation is required : this is the wound. (7)Small incisions are associated with lower surgically induced astigmatism, earlier recovery of visual function, and better preservation of corneal shape. (9)Recently, clear corneal incision temporal approach is increasing in popularity. It is done intracorneally, so cauterization is unnecessary. Easier approach to the surgical site; ease of construction even in deep-set eyes or those with filtering blebs; lack of bleeding or iris prolapse, easy conversion to ECCE, and suitability for topical anesthesia.(28)In the scleral tunnel incision, tunnel preparation and subsequent manipulation are done through the vascularized scleral tissue.(53)While In the clear corneal incision, tunnel preparation and surgical manipulation are done through the avascular cornea. The tunnel is usually shorter than the scleral tunnel resulting in less distortion of the eye during phacoemulsification and irrigation/aspiration. There is no fibrovascular healing in clear corneal incision.(6)However, induced astigmatism increases with proximity of the incision to the central corneal.So, the aim of this thesis is to compare between clear corneal incision and scleral tunnel incision in phacoemulsification as regards:1. Corneal astigmatism.2. Postoperative inflammation.This study included fifty eyes. All of them had cataract and were subjected to cataract extraction with the use of phacoemulsification and implantation of foldable intraocular lenses.They were grouped according to incision location into 2 groups:• Group A: included 25 eyes for which phacoemulsification was done through a clear corneal tunnel incision.• Group B: included 25 eyes for which phacoemulsification was done through a scleral tunnel frown incision.The patients were subjected to careful preoperative evaluation and were scheduled for follow up after 1 day, 1 week, 1 month and 3 months.In group (A) the mean SIA after 1 week was 1.25D which decreased to 0.93D then 0.86D after one and three months respectively.The average cell count was highest on the first 2 days and decreased on subsequent follow up.In group (B) the mean SIA after 1 week was 0.75D which decreased to 0.65D then 0.58D after one and three months respectively.The average cell count was highest on the first 2 days and decreased on subsequent follow up.Comparing the surgically induced astigmatism (SIA) between both groups after one week postoperative three was a significant difference with the scleral tunnel producing less astigmatism, this difference disappeared on the 1 month & 3 months comparisons.On the first postoperative day, the average anterior chamber cell count per field was significantly lower in group A (corneal). On the second postoperative day, the average number of cell count field decreased in both groups but remained significantly lower in the corneal group. On the third postoperative day, there was no statistically significant difference and continues insignificant after one week and one month postoperatively.
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