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Stuti Misra, Sunny Li, Henry Wallace, James Mckelvie; Anterior-segment OCT analysis of corneal incisions in cataract surgery: a comparison of 2.2mm and 2.85mm incision architecture. Invest. Ophthalmol. Vis. Sci. 2018;59(9):4339.
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© ARVO (1962-2015); The Authors (2016-present)
The self-sealing nature of clear corneal incisions in cataract surgery is critical in the immediate postoperative period. However, a gap in literature exists on long term corneal repair and remodelling after surgery. The aim of the current study was to characterize corneal incision architecture, repair, and remodelling with 2.20mm or 2.85mm incisions over a period of three months following cataract surgery.
A prospective, randomized, comparative interventional study design was used to compare incision architecture between 2.2 and 2.85mm keratome sizes. Ninety eight eyes of 98 patients undergoing cataract surgery were recruited and randomly assigned to the uniplanar clear-corneal incision treatment groups. Incision imaging using anterior-segment optical coherence tomography (AS-OCT) and corneal endothelial specular microscopy was completed before the surgery and at one day, one week, one month and three months following surgery. Phacoemulsification parameters were correlated with corneal thickness at the incision before and after surgery. Incision length, gaping, angle, and leakage were analyzed using AS-OCT imaging. All analyses were completed using R statistical software.
Ninety eight patients with mean age of 74.1 years (43M, 55F) were randomly assigned 2.20mm (n=50) or 2.88mm (n=48) incision sizes. The overall mean incision angle was 25.1±4.6o. Corneal thickness at the incision decreased between one day, one week and one month after surgery (P < 0.001). Descemet’s membrane detachments (DMD) were observed in 62% (2.20mm) and 40% (2.85mm, P = 0.005). Endothelial wound gaping (EWG) was observed in 66% (2.20mm) and 48% (2.85mm, P = 0.065) of patients. Increased phacoemulsification time was associated with increased DMD (P = 0.02), EWG (P =0.03), and increased wound thickness (P =0.02). There was no significant endothelial cell density change within the treatment groups following surgery (P = 0.32).
Corneal incision healing is a dynamic long-term process, with an early stage of wound repair observed at one month, and a later stage of remodelling noted at three months following cataract surgery. Smaller incisions, however, may be associated with greater endothelial distress which should be considered for surgery involving corneal pathology likely to further compromise incision healing.
This is an abstract that was submitted for the 2018 ARVO Annual Meeting, held in Honolulu, Hawaii, April 29 - May 3, 2018.
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