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Anne-Laure Jeancolas, Louis Lhuillier, Adina Agapie, Cedric Ghetemme, Oualid Guechi, Francois Ameloot, Shanour Premy, Jean-Marc Perone; Corneal postoperative response after phacoemulsification - Subluxation versus divide-and-conquer. Invest. Ophthalmol. Vis. Sci. 2014;55(13):2526.
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Our study aims at estimating the corneal response immediately after and at 4 days post-operative of a cataract surgery by phacoemulsification according to the operating technique used (subluxation versus divide-and-conquer).
We prospectively included 52 consecutive patients (64 eyes) presenting cataracts of equivalent grades, and operated by phacoemulsification (2.2mm incision) under topical anesthesia in our department between october and november 2013. Two groups were analyzed including respectively 32 eyes for group1 (subluxation) and 32 eyes for group2 (divide-and-conquer). All surgeries were performed by the same experienced surgeon using the Stellaris (Bausch&Lomb,Inc) and foldable flexible IOLs were implanted. Measurements of the central corneal thickness (CCT) were made preoperatively, immediately after and then 4 days after the surgery, using the non-contact tonopachymeter TONOPACHYTM NT-530P (Nidek CO.,Ltd). The main system parameters were: power of ultrasounds US (%), mean US time (TPA), effective US time (TPE), time of operation, % of final suture.
Our study concerned 64 eyes of 12 men (23.1 %) and 40 women (76.9 %), the mean age +/- SD was 72.8 +/-9.0 years, the mean operating times were similar in both groups: 8.4 +/-1.0 mn (group1) and 7.9 +/-1.0 mn (group2). Concerning the increase of CCT on immediate post-operative, we note a significant difference between both groups: 51.56 +/-21.35 µm (group 1) vs 68.78 +/-34.8 µm (group 2) (IC95% [2,21; 32,23], p=0,025). The effective US times were similar in both groups (6,31 +/-3,38 (group1) vs 6,75 +/-2,98 seconds (group2), IC95% [0,93; 2,96], p=0,3). The effective US time was not correlated to the importance of the immediate post-operative corneal oedema and does not condition the recovery on Day4 with a return to the initial CCT in 93 % of the cases. The percentages of final suture were comparable: 35% (group1) against 31% (group2).
Our study shows that the immediate post-operative corneal oedema is significantly less important when using the technique of subluxation than with using the technique of divide-and-conquer, while to post-operative Day4 we note a return to normal of the CCT whatever the technique used.The technique of lens subluxation is until then not described in the literature and turns out to be a reliable and effective method.
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