Impact of Clear Corneal Incision Morphology on Incision-Site Descemet Membrane Detachment in Conventional and Femtosecond Laser-Assisted Phacoemulsification. (4th March 2018)

• Record Type: Journal Article
• Authors: Titiyal, Jeewan S.; Kaur, Manpreet; Ramesh, Priyanka; Shah, Pooja; Falera, Ruchita; Bageshwar, Lalit M. S.; Kinkar, Ashutosh; Sharma, Namrata
• Is Part Of: Current eye research. Volume 43:Number 3(2018)
• Page Start: 293
• Page End: 299
• Publication Date: 2018-03-04
• Subjects: Incision architecture phacoemulsification -- incision site DMD -- FLACS clear corneal incisions; Ophthalmology -- Periodicals; Eye -- Diseases -- Periodicals; Ophthalmology -- Periodicals; 573.88
• DOI: 10.1080/02713683.2017.1396616
• Languages: English
• ISSNs: 0271-3683

Abstract

ABSTRACT: Purpose : To assess intraoperative morphology of clear corneal incisions (CCI) and its impact on incision-site descemet membrane detachment (DMD) in conventional phacoemulsification and femtosecond laser-assisted cataract surgery (FLACS). Methods : Prospective comparative study of 129 eyes that underwent either conventional phacoemulsification (Group I, n = 77) or FLACS (Group II, n = 52) was undertaken at an apex tertiary care ophthalmic setup. In group I, a 2.2-mm metal keratome was used to create a biplanar CCI. In group II, femtosecond laser-assisted biplanar CCI was created with 2.2 mm diameter. Incision architecture and incision-site DMD were assessed using microscope-integrated intraoperative OCT (iOCT) and anterior segment OCT on postoperative day (POD) 1 and 30. Visual acuity was assessed on POD 1 and 30. Results : Smooth slit (SS) or ragged slit (RS) morphology of the proximal opening of CCI was observed immediately after creation [Group I: 68.8% SS, 31.2% RS; Group II: 86.5% SS, 13.5% RS]. DMD was observed in 87.1% cases with RS and 16.3% cases with SS morphology (p < 0.001). DMD was more frequent in group I (Group I = 38/77, Group II = 5/52; p < 0.001) and most commonly observed during the step of stromal hydration (83.7%). DMD was self-resolving and did not persist in any group at 1 month. Visual acuity was comparable in both groups on POD 1 and 30. Conclusion : Ragged morphology of proximal opening of CCI is the most important predictive factor for incision-site DMD. Femtosecond-laser CCIs have less incision-site DMD as compared to keratome-assisted CCIs. iOCT provides real-time assessment of CCI morphology and DMD.