The cataract incision has a major impact on several key aspects of cataract surgery. Instruments must be passed through the incision without excessive manipulation and, during surgery, the instruments must be able to maneuver adequately within the eye to accomplish their goal. The intraocular lens (IOL) must be able to be inserted through the incision. After surgery, the incision may have an impact on astigmatism, generally in the direction of causing flattening of that meridian. Finally, any leakage from the incision has two major associated risks. The first is damage to the corneal endothelium from shallowing or emptying of the anterior chamber, particularly if implanted devices such as an IOL come in contact with the endothelium. The second and worst of the potential complications is the ingress of organisms, resulting in endophthalmitis. All of these factors determine the ultimate selection of incision size and configuration.
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