Assessment of sclerocorneal incision architecture after phacoemulsification using AS-OCT

Abstract

Introduction The construction of the main incision is crucial for the outcome of cataract surgery.  There are many considerations including: wound preparation and stability, surgically induced astigmatism, stability of anterior chamber, and wound closure stability with rising intraocular pressure (IOP). Irrespective of modality, the main goal is to achieve stable watertight self-sealing wound in order to avoid possible intra- and postoperative complications. Therefore, evaluating the architecture and healing of the surgical wound would be of benefit, as the integrity of incisions may decrease the risk of endophthalmitis or other problems. Anterior segment OCT (AS-OCT) provides the opportunity to visualize anterior chamber structures and cornea in particular. In the interest of the current study this was used to examine the anatomy of the main incision in vivo and evaluate its changes over time. Aim The aim of this article is to examine the architecture of the main incision in vivo and evaluate its changes over time, using anterior segment optical coherence tomography (AS-OCT). Materials and Methods Patients diagnosed with senile cataract, scheduled for surgery, were enrolled in this prospective study. All underwent uneventful cataract surgery with phacoemulsification and intraocular lens (IOL) implantation, performed by the same experienced surgeon. A standardized technique of cataract extraction, under local anesthesia, was used. Patients with previous ocular surgery or trauma, and other ocular pathology, as well as cases with complications were not included in the study. Wound anatomy was visualized using AS-OCT (Topcon 3D SD OCT 2000) at three postoperative visits: day 1, day 7, and day 30. The following features were examined and analyzed: external gaping, endothelial (internal) alignment and gaping, localized DMD, loss of coaptation, wound retraction, and other changes on the external or the internal side of the wound. Results Sixty eyes of 51 patients were examined, of whom 23 were men and 28 women, aged between 53 and 87 years (mean 72 years). The scleral tunnel incisions had a three-plane architecture and all of them were watertight with no leakage at any time. Several architectural features were assessed, including epithelial gaping, endothelial gaping and misalignment, local Descemet’s membrane detachment (DMD). Conclusion AS-OCT is a risk-free, quick, high-informative method for visualization of the morphological characteristics of cataract surgical incisions and their evolution over time. Hence, this technology is indispensable in evaluating the integrity of the wound, and the information obtained could be used to develop a consistent technique to create self-sealing incisions and decrease the risk of endophthalmitis.