Intraoperative optical coherence tomography-assisted assessment of corneal wound architecture in conventional and femtosecond laser-assisted phacoemulsification

Session Details

Session Title: Cataract Surgery Equipment/Instrumentation/Surgical Devices II

Session Date/Time: Monday 12/09/2016 | 17:00-18:30

Paper Time: 18:10

Venue: Hall C1

First Author: : J.Titiyal INDIA

Co Author(s): :    M. Kaur   P. Ramesh   R. Falera   R. Sinha           

Abstract Details

Purpose:

To compare the morphology of clear corneal incisions in cases undergoing conventional phacoemulsification and Femtosecond laser assisted cataract surgery (FLACS) with the microscope integrated intraoperative optical coherence tomography (iOCT).

Setting:

Dr. R.P. Centre for Ophthalmic Sciences, AIIMS, New Delhi, India

Methods:

Forty eyes that underwent either conventional co-axial phacoemulsification (Group I, n=20) or FLACS (Group II, n=20) were prospectively evaluated. In Group I, a 2.2 mm keratome was used to make the temporal clear corneal incision. In Group II, a biplanar 2.2 mm clear corneal incision was created using femtosecond laser. Wound architecture and descemet membrane detachment (DMD) was assessed using iOCT in all cases after creating the incision, phacoemulsification, irrigation-aspiration (IA), intraocular lens (IOL) insertion and stromal hydration at the end of the surgery. Anterior segment OCT was done in all cases on the first postoperative day (POD 1).

Results:

Ragged slit (RS) or smooth slit (SS) morphology of corneal incisions was observed; SS in 70% (14/20) cases in group I, 90% (18/20) in group II and RS in 30% (6/20) cases in group I, 10% (2/20) in group II. DMD occurred in 87.5% (7/8) cases with RS (Group I=6/6, Group II= 1/2), 15.6% (5/32) cases with SS (Group I=4/14, Group II=1/18) (p=0.003). DMD occured during final stromal hydration in 83.3% cases (10/12). Intraoperative DMD was more frequently observed in group I (Group I=10/20, Group II=2/20; p=0.014); however, no difference was observed between the two groups on POD 1(Group I=4/20, Group II=1/20; p=0.34).

Conclusions:

The morphology of the corneal incision is the most important predictive factor with RS morphology predisposing to wound site DMD. Maximum incidence of DMD is observed during the step of final stromal hydration. Femtosecond laser creates biplanar corneal incisions with superior wound apposition and a lesser incidence of wound-site DMD than keratome-assisted corneal incisions.

Financial Disclosure:

NONE