Review: Phaco Incision OCT Analysis

The phaco incision is part of your signature which links you to the patient’s eye forever. Your incision will forever be visible to any doctor who examines the patient at the slit lamp. And more importantly, it can affect the patient’s vision forever if it induces a significant degree of astigmatism.

This video shows both the microscope view and then the OCT video analysis of the phaco incision. The surgeon in this video is a young and talented resident ophthalmologist who has completed about 200 cataract surgeries so far. This young ophthalmologist has a different approach to the phaco incision than me: I usually prefer a single-plane approach whereas his technique is tri-planar.

This young surgeon first starts with a shallow, 100 micron groove at the gray line of the limbus. Next the keratome is used to create an appropriate tunnel length in the corneal stroma and then finally, a change in the keratome allows it to penetrate into the anterior chamber. The result is a beautifully performed tri-planar incision. If you are keeping score, this young resident surgeon does a great job and earns an A+ in my book!

Click below to see the video of this incision and then the live OCT analysis:


  1. I use a coaxial irrigation aspiration cannula to do I/A. Any tips on how to remove visco from behind the lens. You seem to do it so effortlessly.

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