Incidence and Risk Factors for Berger’s Space Development after Uneventful Cataract Surgery: Evidence from Swept-Source Optical Coherence Tomography

Abstract

Background: This study investigates the incidence and risk factors for the development of Berger’s space (BS) after uneventful phacoemulsification based on swept-source optical coherence tomography (SS-OCT). Methods: Cataractous eyes captured using qualified SS-OCT images before and after uneventful phacoemulsification cataract surgery were included. Six high-resolution cross-sectional anterior segment SS-OCT images at 30° intervals were used for BS data measurements. BS width was measured at three points on each scanned meridian line: the central point line aligned with the cornea vertex and two point lines at the pupil’s margins. Results: A total of 223 eyes that underwent uneventful cataract surgery were evaluated. Preoperatively, only two eyes (2/223, 0.9%) were observed to have consistent BS in all six scanning directions. BS was observed postoperatively in 44 eyes (44/223, 19.7%). A total of 13 eyes (13/223, 5.8%) with insufficient image quality, pupil dilation, or lack of preoperative image data were excluded from the study. A total of 31 postoperative eyes with BS and 31 matched eyes without BS were included in the final data analysis. The smallest postoperative BS width was in the upper quadrant of the vertical meridian line (90°), with a mean value of 280 μm. The largest BS width was observed in the opposite area of the main clear corneal incision, with a mean value > 500 μm. Conclusions: Uneven-width BS is observable after uneventful phacoemulsification. Locations with a much wider BS (indirect manifestation of Wieger zonular detachment) are predominantly located in the opposite direction to the main corneal incisions.

Anterior vitreous detachment and retrolental material during cataract surgery: incidence and risk factors, with pathological evidence

“…Zhang et al proposed that AVD is often found contralateral to the corneal incision. 11 More importantly, granular materials were found behind the posterior lens capsule in 40.3% of cases. This high incidence has not received much attention from cataract surgeons.…”

“…8 Recently, Zhang et al reported that the incidence of AVD in phakic eyes with cataract was only 0.9%; however, the incidence of AVD was 19.7% after phacoemulsification cataract surgery. 11 Anisimova et al and Vael et al reported that the intraoperative incidence of AVD was 75.0% and 63.0%, respectively. 7,8 There were considerable differences between the studies.…”

Vitreous-lens interface changes after cataract surgery using active fluidics and active sentry with high and low infusion pressure settings

“…13 Zhang et al visualized Berger space with SS-OCT postoperatively in 19.7% of patients who underwent uneventful phacoemulsification with no risk factors of AHD. 14 They used ultrasound power up to 40%, vacuum 500 mm Hg, and GFS to provide passive infusion at 95 to 110 cm above the eye level. The authors associated Berger space development with a higher irrigation pressure (P < .001) and shorter surgery duration (P = .021).…”

“…However, in our and previous studies, despite its high incidence, no case of positive Berger space or AHD presented with AFMS, which probably means that AHD is not a sufficient condition for AFMS to occur. [14][15][16]19 Santos-Bueso evaluated the presence of the Berger space using AS-OCT in 90 patients, and he found it in 3 patients. 20 Mori et al evaluated the visibility of AHM in the retrolental space of normal human eyes, and AHM was seen in 6.9% of eyes examined with the deep-range AS-OCT. 21 In this study, postoperatively, eyes with Berger space had higher irrigation pressure and suggest that a comprehensive consideration of irrigation pressure and surgical time may better reflect the effects of cataract surgery on the vitreolenticular interface.…”

Editorial: Imaging in Ophthalmology

“…Over the last decade, ophthalmology has significantly benefited from advances in vivo non-invasive ophthalmic imaging techniques that play currently a fundamental role in the clinical assessment, diagnosis, management, and monitoring of a wide variety of conditions involving both the anterior and posterior segment [1][2][3][4][5][6]. Imaging technologies, including anterior and posterior segment optical coherence tomography (OCT), OCT angiography, wide-field retinal imaging, specular and confocal microscopy, corneal topography, and ocular ultrasound, have dramatically improved the morphological and functional evaluation of ocular structures, both in healthy and pathological eyes [1][2][3][4][5][6][7][8][9][10][11].…”