Effect of phacoemulsification incision size on incision repair and remodeling: Optical coherence tomography assessment

Li, Sunny S.; Misra, Stuti; Wallace, Henry B.; McKelvie, James

doi:10.1016/j.jcrs.2018.07.025

Cited by 12 publications

(31 citation statements)

References 24 publications

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“…Based on previous reports, the posterior incisional retraction increased over time independent of incision size, presence of a Descemet's membrane detachment, and wound gaping. This retraction may be associated with incisional remodeling [12] that continues slowly for a long time postoperatively [22]. The current result that posterior incision retraction increased at 3 months postoperatively was consistent with previous reports [12], and might be caused by IOL implantation when an oversized cartridge tip is used for the corneal incision width.…”

Section: Plos Onesupporting

confidence: 89%

“…According to those data, the calculated circumference of the ellipsoid cartridge tip of the AutonoMe is 5.497 mm, which is much larger than the circumference of a fully dilated 2.4-mm incision (4.8 mm). The current results verified that the AutonoMe can deliver an IOL with less trauma compared with the MX60 injector system [12]. Considering this, some degree of incisional stretching and trauma may occur intraoperatively using this system.…”

Section: Plos Onesupporting

confidence: 77%

“…al reported that endothelial-side wound gaping occurred in 66% of cases 1 day postoperatively in patients with a 2.2-mm incision, i.e., which exceeded the calculated circumference, and decreased to 5.8% 3 months postoperatively. In our study, the rate of endothelial-side wound gaping was higher than that reported by Li et al [12], and the rate of the endothelial-side wound gaping remained 24% even 3 months postoperatively. This contradicts the excellent data obtained from Descemet's membrane detachments and warrants further investigation.…”

Section: Plos Onecontrasting

confidence: 73%

“…The AS-OCT images of the main incision were acquired on 1 day, 1 week, and 1 and 3 months postoperatively. The time-wise changes in the corneal incision site were evaluated using AS-OCT, according to a previous report [12]. The gaping of the epithelial-side and endothelial-side incisions, posterior incision retraction, and Descemet's membrane detachment were recorded as present or absent.…”

Section: Anterior-segment Optical Coherence Tomography (As-oct) Evalumentioning

confidence: 99%

“…Regarding the postoperative wound repair, Li et al reported a detailed comparison of the wound repair and remodeling between different incision sizes (2.2 mm versus 2.85 mm) after cataract surgery using AS-OCT [12]. According to that study, 1 day postoperatively, Descemet's membrane detachments, which were most likely to have resulted from mechanical injury intraoperatively [19,20], occurred in 62% and 40% of patients in the 2.20-mm and the 2.85-mm incision groups, respectively, i.e., over the calculated circumference and under the calculated circumference of 5.21 mm, respectively.…”

Section: Plos Onementioning

confidence: 99%

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Refractive stability of a new single-piece hydrophobic acrylic intraocular lens and corneal wound repair after implantation using a new automated intraocular lens delivery system

et al. 2020

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To investigate refractive stability and characterize corneal incision repair up to 3 months after implantation of a new hydrophobic acrylic intraocular lens (IOL) with hydroxyethylmethacrylate using a new automated IOL delivery system. Methods This prospective case series included 50 eyes of 50 patients undergoing phacoemulsification and implantation of the Clareon ® CNA0T0 IOL using the AutonoMe ® automated delivery system in the Department of Ophthalmology, Keio University School of Medicine. The clinical data were collected from 46 eyes of 46 patients preoperatively and 1 day, 1 week, and 1 and 3 months postoperatively. Endothelial-side incision gaping, posterior incision retraction, and Descemet's membrane detachment were recorded as present or absent using anteriorsegment optical coherence tomography postoperatively. Results The uncorrected distance and corrected distance visual acuities improved and stabilized 1 week postoperatively. The anterior chamber depth was stable from 1 week postoperatively. The subjective refraction was stable from 1 day postoperatively. Descemet's membrane detachments and endothelial-side wound gaping were seen in 19 (41.3%) eyes and 34 (73.9%) eyes 1 day postoperatively and decreased gradually. Posterior incision retraction was seen in eight eyes (17.4%) on day 1 and increased to 19 eyes (41.3%) 3 months postoperatively.

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Section: Plos Onesupporting

confidence: 89%

Section: Plos Onesupporting

confidence: 77%

Section: Plos Onecontrasting

confidence: 73%

Section: Anterior-segment Optical Coherence Tomography (As-oct) Evalumentioning

confidence: 99%

Section: Plos Onementioning

confidence: 99%

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Refractive stability of a new single-piece hydrophobic acrylic intraocular lens and corneal wound repair after implantation using a new automated intraocular lens delivery system

et al. 2020

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Real-Time Imaging of Incision-Related Descemet Membrane Detachment During Cataract Surgery

et al. 2021

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Key Points Question When and how does incision-related Descemet membrane detachment (DMD) occur during cataract surgery? Findings In this case series of 133 patients with cataract, DMD was found in 125 cataract operations (94.0%) and occurred mostly during the phacoemulsification step (69 cases [55.2%]); DMD also increased throughout surgery. Meaning These findings suggest that incision-related DMD mainly occurs during the surgical steps in which the instruments create the greatest friction at the incision site and that severity is associated with the level of ultrasonic energy and length of time of phacoemulsification.

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Statistical Significance vs Clinical Significance—That Is the Question

Rose‐Nussbaumer

2021

JAMA Ophthalmol

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Microincision cataract surgery, defined as wounds of around 2 mm or smaller, have been shown to reduce surgically induced astigmatism compared with smallincision cataract surgery wounds of 3 mm or greater. 1 Therefore, cataract surgeons have intuitively concluded that the smaller the wound, the better, with regard to wound stability and topographic neutrality. However, 2.2-mm incisions have been shown to increase small Descemet membrane detachments (DMD) on postoperative day 1 compared with 2.85-mm incisions and, in 1 study, these detachments translated into slower visual recovery for patients. 2 To address these concerns, Dai et al 3 studied trapezoidal wound construction where the internal wound is 3 mm, while the external wound remains at 2.2 mm. They showed a reduced incidence of DMD vs conventional incision design on postoperative day 1 but no sustained difference in the number of DMD or any other clinical measure between groups. Although their study design and execution are to be congratulated, one is left to wonder about the clinical significance of these findings. There are 3 main reasons why the clinical relevance may be limited including the study concept, a shortterm anatomic difference without clear impact on clinical outcomes, and generalizability.

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Effect of phacoemulsification incision size on incision repair and remodeling: Optical coherence tomography assessment

Cited by 12 publications

References 24 publications

Refractive stability of a new single-piece hydrophobic acrylic intraocular lens and corneal wound repair after implantation using a new automated intraocular lens delivery system

Refractive stability of a new single-piece hydrophobic acrylic intraocular lens and corneal wound repair after implantation using a new automated intraocular lens delivery system

Real-Time Imaging of Incision-Related Descemet Membrane Detachment During Cataract Surgery

Statistical Significance vs Clinical Significance—That Is the Question

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