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Filbert Nguyen, Anthony Trace, Luke Moore, Debora Garcia-Zalisnak, Fredric J. Gross; Changes in Corneal Thickness Following Two Different Techniques of Nucleofractis in Resident Cataract Surgery. Invest. Ophthalmol. Vis. Sci. 2017;58(8):1806.
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© ARVO (1962-2015); The Authors (2016-present)
To evaluate the change in central corneal thickness (CCT) at one week following uncomplicated phacoemulsification performed by resident surgeons using either pop-and-chop (P&C) or divide-and-conquer (D&C) nucelofractis.
This was a prospective, randomized study of patients undergoing non-complex cataract surgery by resident surgeons at the Hampton Veterans Affairs Medical Center between July 2015 and December 2016. Cases complicated by trauma, pseudoexfoliation, or prior ocular surgery were excluded. Additionally, cases with intra-operative complications were excluded. Patient’s demographics, pre-operative CCT (central corneal thickness), case time, CDE, ultrasound time, aspiration volume (asp-V), and post-operative CCT at POD7 (post-operative day 7) were recorded for the two methods. Changes in CCT were compared using the Student’s t-test. Relationships between CCT at POD7 and the studied variables were tested using a Pearson’s correlation.
115 eyes met inclusion criteria. There was no difference in demographic data or pre-operative CCT (p=0.17) between the two groups. Of the 115 eyes, 59.6% (n=69) underwent D&C and 40.4% (n=46) underwent P&C. P&C was significantly faster (22.8 vs 27.2 min, p=0.03) and used significantly less ultrasound (8.5 vs 15.27 CDE, p=0.001) than D&C. There was a statistically significant increase between average pre-operative and POD7 CCT in both P&C (53.0+ 49.2, p<0.001) and D&C (30.8+ 38.5, p<0.001). The change in CCT at POD7 was not statistically significant between the two techniques (p=0.08). There was a significant correlation between CDE (r2=0.18, p=0.0003), case time (r2=0.16, p=0.0006), ultrasound time (r2=0.19, p=0.0002), and asp-V (r2=0.15, p=0.001) when compared with change in CCT at POD7 in the D&C group. No significant correlation was seen in the P&C group: CDE (r2=0.0004, p=0.89), case time (r2=0.009, p=0.53), ultrasound time (r2=0.002, p=0.77), and asp-V (r2=0.001, p=0.82).
P&C phacoemulsification is a faster and more energy efficient technique for cataract extraction than D&C when performed by resident surgeons. This study found no significant difference in the change in CCT on POD7 between the two techniques. Increased case time, CDE, ultrasound time, and aspiration volume and time are correlated to increased corneal swelling in D&C but not P&C. The reason for this difference is unclear and needs further study.
This is an abstract that was submitted for the 2017 ARVO Annual Meeting, held in Baltimore, MD, May 7-11, 2017.
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