November 2018

RESIDENTS

EyeWorld journal club
OCT analysis of phacoemulsification incisions: could tighter incisions delay recovery? A prospective randomized trial of 2.2 mm versus 2.85 mm incisions


by Sunny Li, BMedSc(Hons), Stuti Misra, BOptom, PhD, Henry Wallace,
BMedSc(Hons), James McKelvie, MBChB, PhD

J Cataract Refract Surg. 2018;44(11):1333–1335.

Purpose: To characterize the effect of incision size on corneal incision repair and remodeling over 3 months following cataract surgery.
Setting: Department of Ophthalmology, Auckland District Health Board, New Zealand
Design: Prospective double-masked randomized study
Methods: One hundred eyes of 100 patients undergoing routine cataract surgery were randomized to receive uniplanar clear corneal incisions of 2.20 mm or 2.85 mm. Anterior segment optical coherence tomography (AS-OCT) and specular microscopy were completed at baseline and day 1, 7, 30, and 90 following surgery. Incision thickness, length, width, gaping, and angle were analyzed using AS-OCT. Endothelial cell density (ECD), polymegathism, and pleomorphism were assessed using specular microscopy.
Results: Of 100 recruited patients, 50 were allocated to each incision group. Ninety-nine patients (99%) attended all assessments. Incisions of 2.20 mm were associated with over 50% more Descemet’s membrane detachments (DMD, P=0.01). Patients with DMDs demonstrated increased endothelial wound gaping, slower visual recovery, and increased corneal thickness at the incision site at all visits (φ=0.54, P<0.01). The 2.20 mm incision group demonstrated greater polymegathism despite no difference in phacoemulsification energy between treatment groups (2.20 mm=32.3±6.2%; 2.85 mm=30.8±6.5%, P=0.02). At day 90 following surgery, 2.20 mm incisions demonstrated lower ECD (2195±360 cells/mm2) than the 2.85 mm group (2397±335 cells/mm2, P=0.01). Final visual acuity, gaping, and angles was not significantly different between the incision groups.
Conclusions: Corneal incisions with a width of 2.2 mm are more prone to trauma than 2.85 mm incisions during routine cataract surgery. Corneal incisions with signs of trauma are associated with prolonged visual recovery and slower healing following surgery.

OCT analysis of phacoemulsification incisions: could tighter incisions delay recovery? A prospective randomized trial of 2.2 mm versus 2.85 mm incisions OCT analysis of phacoemulsification incisions: could tighter incisions delay recovery? A prospective
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2018-10-30T14:32:26Z
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