<p>Architecture evaluation of the main clear corneal incisions in femtosecond laser-assisted cataract surgery by optical coherence tomography imaging</p>

Abstract

Purpose To assess the stability and reliability of femtosecond laser-assisted cataract surgery (FLACS) incisions design and dimensions using anterior segment optical coherence tomography (AS-OCT) imaging. Setting Renato Ambrósio Ophthalmologic Study Center from Hospital Oftalmológico de Brasília, Brasília, Brazil. Design Prospective nonrandomized controlled case series. Methods Eyes undergoing FLACS with triplanar main temporal clear corneal incision (CCI) were evaluated at the end of the case. Eyes that required any incision hydration, surgical complications or lacked follow-up were excluded. The AS-OCT was performed after femtosecond delivery; at the end of the case; at 1 day and at 30 days after surgery. Data of pachymetry, endothelial and epithelial gaps, Descemet detachment and CCI architecture were compared. Results Eleven eyes from 11 patients completed follow-up. Corneal thickness was statistically different between after femtosecond delivery and the end of the case ( P -value <0.05), but without difference compared to 30 days evaluation. There was an increase of Descemet detachments ( P -value <0.05) and endothelial gaps ( P -value =0.0133) at the end of the case compared to post-femtosecond delivery. As for the architecture of the CCI, significant difference was found between the parameters of entry angle and exit angle measured with AS-OCT and the programmed. Conclusion The AS-OCT was capable of visualizing changes in the cornea at the CCI. Despite the stress caused by manipulation, results indicated good stability of incision and reproducibility of tunnel length. Synopsis Difference of corneal thickness at the CCI between after femtosecond and after phacoemulsification measurements ( P -value <0.05), with increase of endothelial gaps ( P -value =0.0133) and Descemet detachments ( P -value <0.05).

Comparison of wound architecture in implantable collamer lens surgery: Self-sealing single-plane opposite clear corneal incision versus main surgical incision

“…22 Triplanar incisions are more accurate and effective when using the femtosecond laser, achieving good wound coaptation without the need for additional hydration. 8,23 Single-plane incisions are easier to make; however, their tightness can be compromised in wide and shorter incisions. Arched single-plane incisions in which the length of the arcuate incision is longer than its incision chord appear to be safer in terms of wound tightness and the sliding of one lip over another.…”

“…12 The total sealing surface damage of the incision and local DMD tend to appear spontaneously during the first few weeks after surgery, disappearing several months later. 8,12 Nevertheless, it seems that endothelial misalignment persists and increases in the late postoperative period. 12 Although there appears to be a consensus in the literature on the changes that occur in the architecture of main cataract surgery incisions, to the best of our knowledge, no studies have been published on the changes produced by astigmatic incisions without manipulation.…”

“…The architecture of the main surgical incision (MSI) in cataract surgery has been extensively studied. [7][8][9][10][11][12][13][14] In the early post-operative period, a certain degree of epithelial and endothelial gap, 8,15 local Descemet's membrane detachment (DMD) 8 and subsequent misalignment of the endothelial incision or endothelial retraction can be observed using anterior segment optical coherence tomography (AS-OCT). 12 The total sealing surface damage of the incision and local DMD tend to appear spontaneously during the first few weeks after surgery, disappearing several months later.…”

Effect of corneal incision features on anterior and posterior corneal astigmatism and higher‐order aberrations after cataract surgery

“…Previous studies have reported a range of incidences for patients who had defective incisions. This might be due to the discrepancies in surgical techniques, including femtosecond laser-created CCI (Alio et al 2013;Grewal & Basti 2014;Chaves et al 2019), incision width (Li et al 2011;Li et al 2018), stromal hydration (Fukuda et al 2011;Bang et al 2015), postoperative drug usage (Choi et al 2016) and measuring principles. The frequency of the DMD and wound misalignment at 1 month was similar to previous studies (Wang et al 2012;Li et al 2018;Rodrigues et al 2019).…”