This activity is supported by an educational grant from Abbott Medical Optics, Inc.
A 21-guage needle creates a smaller incision, while a 20-guage needle creates a slightly larger incision. A larger incision reduces clogging at the phaco tip and requires lower vacuum settings, which reduces the risk for post-occlusion surge. However, larger incisions tend to be less water-tight and can induce more astigmatism.
While incision and needle size largely depend on the surgeon’s preference, many surgeons have moved away from the “smaller is better” philosophy. The incision must be large enough to allow for a safe and efficient cataract surgery, including insertion of the IOL. The optimal incision size is usually between 2.2 mm to 2.4 mm. Some surgeons think that fluidics is compromised when the incision is less than 2.2 mm and that it is not worth the trade-off in efficiency and safety.
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