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Effect of high and low phaco fluidics on postoperative corneal endothelial counts and central sub-foveal macular thickness

Session Details

Session Title: Subluxed IOLs and Scleral Fixation

Session Date/Time: Wednesday 09/10/2013 | 08:00-10:30

Paper Time: 09:55

Venue: E102 (First Floor)

First Author: : S.Das INDIA

Co Author(s): :    S. Ganesh   S. Nagappa   M. Kurian   M. Sayee   R. Shetty   B.

Abstract Details

Purpose:

To find out the safety of high flow parameters during phacoemulsification, on the corneal endothelium and sub-foveal macular thickness compared to low flow parameters. Cystoid macular oedema (CME) has been reported following phacoemulsification. Turbulence and chatter during phacoemulsification can have an effect on the corneal endothelium and also cause greater realease of prostaglandins during surgery. The prostaglandins could result in an increased incidence of cystoid macular edema. High flow rates could be associated with higher intraoperative prostaglandin release due to turbulence. We tried to find out the effect of differenct flow parameters on the corneal endothelium and cystoid macular edema

Setting:

Narayana Nethralaya, Bangalore, a tertiary eye care center and postgraduate institute of ophthalmology

Methods:

130 patients were randomized into high of low flow groups. They were age and sex matched. Each group was further divided into 2 sub-groups depending on whether the cataract was LOCS-3 Nucleus Grade 4 (or above) or below Grade 4.Patients with co-morbidities were excluded. Pre-operatively the uncorrected visual acuity (UCVA), best corrected visual acuity (BCVA), slit lamp microscopy (SLE) and LOCS-3 grading, intraocular pressure, specular microscopy and macular OCT for sub-foveal macular thickness were done. Where the macular OCT could not be done pre-operatively, it was done on the 1st post-operative day (POD). The high & low flow parameters were defined and set. All surgeries were performed by the same surgeon on the Alcon Infinity machine. The total surgical time, cumulative dissipated energy, amount of fluid used, phaco time & intra-operative complications were noted. The UCVA, BCVA, SLE, IOP & Specular Microscopy was done on the 1st POD and on the 6th and 12 th weeks. The macular OCT was repeated in the 6th and 12th week postop. Statistical analysis was done on the completion of the study.

Results:

The cumulative dissipated energy was significantly less in the low flow group and the amount of fluid used was significantly less in the high flow group. These were statistically significant. There was no statistical difference in any of the other parameters measured. There was no difference in the complication rates either

Conclusions:

Though there some differences in the CDE and the quantum of fluid used, there seemed to be no effect on either the corneal endothelium or in the incidence of CME. This indicates that flow parameters could be safely set according to the surgeon"s preference and comfort levels without worrying about the deleterious effect on the eye.

Financial Interest:

NONE